Novel combination and use of antibodies

ABSTRACT

Described is the use of a first antibody molecule that specifically binds FcγRIIb via its Fab region, but lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, for use in combination with a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein the binding of the second antibody molecule to the receptor on the immune cell causes depletion and/or deactivation of the immune cell in the treatment of an FcγRIIb-negative cancer in a patient, as well as pharmaceutical compositions and kits comprising these to antibody molecules, and methods of treating cancer using these two antibodies.

FIELD OF THE INVENTION

The present invention relates to the combined use of 1) an antibody molecule that specifically binds FcγRIIb via its Fab region, but lacks Fc region or has reduced binding via its Fc region to at least one Fcγ receptor, and 2) an immune cell depleting or deactivating antibody molecule that specifically binds to a receptor present on an immune cell that suppresses anti-cancer immunity and which immune cell depleting or deactivating antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, in treatment of FcγRIIb-negative cancers.

BACKGROUND OF THE INVENTION

It has long been appreciated that the inhibitory Fc gamma receptor (FcγR) IIB, expressed by numerous cells of the immune system, negatively regulates both innate and adaptive immunity through engagement of immune complexes (IC). Similarly, the knowledge that FcγRIIB negatively regulates monoclonal antibody mediated immunotherapy has been known for over a decade. As such, FcγRIIB-deficient mice are able to clear tumours more effectively than wild type (WT) mice when treated with therapeutic mAbs, indicating that FcγRIIB expression on effector cells (i.e., macrophages and monocytes) leads to suppression of their phagocytic and cytotoxic potential in vivo. Moreover, FcγRIIB regulates the antigen-presenting potential of dendritic cells (DC) and FcγRIIB—ve (van Montfoor et al., J Immunol. 2012 Jul 1; 189(1):92-101). DCs have an improved capacity to activate naive T cells. Recently, antagonist antibodies that block FcγRIIB-signalling and internalization in B cells were developed. Such antibodies showed efficient deletion of FcγRIIB-expressing B cells, and efficiently boosted rituximab-mediated deletion of normal and malignant B cells, demonstrating a utility in hematologic cancer. It was, however, not examined or demonstrated whether such antibodies would have utility also in treatment of FcγRIIB negative cancers, such as solid cancers.

SUMMARY OF THE INVENTION

We here show, unexpectedly, that only anti-FcγRIIB antibodies lacking Fc region, or whose Fc-region shows reduced or impaired binding to FcγRs e.g. F(ab)′₂ antibodies or aglycosylated antibodies, are able to enhance the therapeutic activity of antibodies used for treatment of FcγRIIB-negative cancers, including solid cancers. This finding was unexpected, since previous studies had indicated that wild-type IgG1 anti-FcγRIIB anti-bodies were equally capable of blocking FcγRIIB receptors, and equally capable of pre-venting rituximab internalization and rituximab-induced FcγRIIB phosphorylation in vitro.

According to the present invention it is possible to enhance the therapeutic activity of immunomodulatory anti-cancer antibodies, whose therapeutic activity is dependent on engagement of FcγRs. Such antibodies include, but are not limited to, antibodies to so called checkpoint inhibitor targets, e.g. CTLA-4, immune agonist targets, e.g. OX40, 4-1BB, and GITR, and the interleukin-2 receptor (IL-2R).

Disclosed herein is a first antibody molecule that specifically binds FcγRIIb via (or through) its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via (or through) its Fc region, for use in combination with

a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein the binding of the second antibody molecule to the receptor on the immune cell causes depletion and/or deactivation of the immune cell;

in the treatment of an FcγRIIb-negative cancer in a patient.

Disclosed herein is also a pharmaceutical composition comprising:

(i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and

(ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein binding of the second antibody to the receptor on the immune cell causes depletion and/or deactivation of the immune cell;

for use in the treatment of an FcγRIIb-negative cancer in a patient.

Disclosed herein is further a kit for use in the treatment of an FcγRIIb-negative cancer comprising:

(i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has a reduced binding to Fcγ receptors via its Fc region, and

(ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein binding of the second antibody molecule to the receptor on the immune cell causes depletion or deactivation of the immune cell.

Further disclosed herein is the use of:

(i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and

(ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein the binding of the second antibody to the receptor on the immune cell causes depletion or deactivation of the immune cell;

in the manufacture of a medicament for use in the treatment of an FcγRIIb-negative cancer in a patient.

Disclosed herein is also a method for treatment of an FcγRIIb-negative cancer in a patient, comprising administering:

(i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and

(ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that is capable of activating at least one activating Fey receptor, and wherein the binding of the second antibody to the receptor on the immune cell causes depletion or deactivation of the immune cell.

DETAILD DESCRIPTION OF THE INVENTION

Thus, the present invention concerns the combined use of:

(i) an antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fey receptors via its Fc region (below often denoted a first antibody molecule or the first antibody molecule), and

(ii) an antibody molecule that specifically binds to a receptor present on an immune cell (below often denoted a second antibody or the second antibody), wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which antibody molecule has an Fc region that binds to at least one activating Fey receptor, and wherein the binding of this antibody molecule to the receptor on the immune cell causes depletion or deactivation of the immune cell. This second antibody molecule is thus an immune cell depleting or deactivating antibody molecule.

This combination is intended to be used in the treatment of an FcγRIIb-negative cancer in a patient, with the aim to improve therapeutic efficacy of the second antibody molecule through enhanced binding of its Fc part to activatory FcγRs, with reduced binding/activation of inhibitory FcγR.

Fc receptors are membrane proteins which are found on the cell surface of immune effector cells, such as macrophages. The name is derived from their binding specificity for the Fc region of antibodies, which is the usual way an antibody binds to the receptor. However, certain antibodies can also bind the Fc receptors via the antibodies' CDR sequences in the case of antibodies specifically binding to one or more Fc receptors.

A subgroup of the Fc receptors are Fcγ receptors (Fc-gamma receptors, FcgammaR), which are specific for IgG antibodies. There are two types of Fcγ receptors: activating Fcγ receptors (also denoted activatory Fcγ receptors) and inhibitory Fcγ receptors. The activating and the inhibitory receptors transmit their signals via immunoreceptor tyrosine-based activation motifs (ITAM) or immunoreceptor tyrosine-based inhibitory motifs (ITIM), respectively. In humans, FcγRIIb (CD32b) is an inhibitory Fcγ receptor, while FcγRI (CD64), FcγRIIa (CD32a), FcγRIIc (CD32c), FcγRIIIa (CD16a) and FcγRIV are activating Fcγ receptors. FcygRIIIb is a GPI-linked receptor expressed on neutrophils that lacks an ITAM motif but through its ability to cross-link lipid rafts and engage with other receptors is also considered activatory. In mice, the activating receptors are FcγRI, FcγRIII and FcγRIV.

It is well-known that antibodies modulate immune cell activity through interaction with Fcγ receptors. Specifically, how antibody immune complexes modulates immune cell activation is determined by their relative engagement of activating and inhibitory Fcy receptors. Different antibody isotypes bind with different affinity to activating and inhibitory Fcγ receptors, resulting in different A:I ratios (activation:inhibition ratios) (Nimmerjahn et al; Science. 2005 Dec. 2; 310(5753):1510-2).

By binding to an inhibitory Fcγ receptor, an antibody can inhibit, block and/or downmodulate effector cell functions.

By binding to an activating Fcγ receptor, an antibody can activate effector cell functions and thereby trigger mechanisms such as antibody-dependent cellular cytotoxicity (ADCC), antibody dependent cellular phagocytosis (ADCP), cytokine release, and/or antibody dependent endocytosis, as well as NETosis (i.e. activation and release of NETs, Neutrophil extracellular traps) in the case of neutrophils. Antibody binding to an activating Fcγ receptor can also lead to an increase in certain activation markers, such as CD40, MHCII, CD38, CD80 and/or CD86.

The antibody molecule according to the invention that specifically binds FcγRIIb, i.e. the first antibody, binds to or interacts with this Fcγ receptor via the Fab region of the antibody, i.e. via the antigen-binding region on an antibody that binds to antigens which is composed of one constant and one variable domain of each of the heavy and the light chain. In particular, it binds to FcγRIIb present on an immune effector cell, and in particular to FcγRIIb present on the surface of an immune effector cell. If this antibody would have had a usual or ordinary Fc region, the antibody could also have bound to an activating Fcγ receptor through normal interaction between the Fc region and Fc receptor. However, according to the invention, the antibody molecule that specifically binds FcγRIIb completely lacks Fc region or has reduced binding to Fcγ receptors, which means that the antibody molecule that specifically binds or interacts with FcγRIIb binds poorly to or cannot at all bind to or interact with Fcγ receptors. This appears to have at least two therapeutically important consequences:

1) lack of Fc-mediated binding to activatory FcγRs leaves a greater number of activatory Fc gamma receptors available for binding to Fc's of (other) therapeutic anticancer antibodies. This is important since clustering of an increasing number of activatory FcγRs (vs inhibitory FcγRs; Nimmerjahn et al; Science. 2005 Dec. 2; 310(5753):1510-2) is known to increase effector cell mediated target cell deletion, a mechanism underlying activity of both checkpoint inhibitor, immune agonist, and other immunomodulatory antibodies, such as anti-IL-2R.

2) lack of, or reduced, Fc-mediated binding to inhibitory FcγR was shown to reduce inhibitory signalling in FcγR-expressing immune effector cells. Thus, lack of or reduced Fc-mediated binding to FcγR of the FcγRIIB targeting antibody likely improves therapeutic efficacy by at least two mechanisms, involving both improved activatory FcγR and reduced inhibitory Fcγ signalling in immune effector cells in response to a second immunomodulatory anti-cancer antibody.

“Reduced binding” or “binding with reduced affinity” means in this context that antibody molecule has reduced Fc mediated binding to Fcγ receptors, or in other words that the Fc region of the antibody molecule that specifically binds FcγRIIb binds to an activating Fcγ receptor with lower affinity than the Fc region of a normal human IgG1. The reduction in binding can be assessed using techniques such as surface plasmon resonance. In this context “normal IgG1” means a conventionally produced IgG1 with a non-mutated Fc region that has not been produced so as to alter its glycosylation. As a reference for this “normal IgG1” it is possible to use rituximab produced in CHO cells without any modifications (Tipton et al, Blood 2015 125:1901-1909; rituximab is described i.a. in EP 0 605 442).

“Reduced binding” means that binding of the Fc region of the antibody molecule that specifically binds FcγRIIb binds to an activating Fcγ receptor is at least 10 fold reduced for all Fc receptors compared to the binding of the Fc region of a normal human IgG1 to the same receptors. In some embodiments it is at least 20 fold reduced. In some embodiments it is at least 30 fold reduced. In some embodiments it is at least 40 fold reduced. In some embodiments it is at least 50 fold reduced. In some embodiments it is at least 60 fold reduced. In some embodiments it is at least 70 fold reduced.

In some embodiments of the present invention, the antibody molecule that specifically binds FcγRIIb does not bind at all with its Fc region, and in some such cases the antibody does not have an Fc region; it may then be a Fab, Fab′2, scFv or PEGYLATED versions thereof.

In some embodiments, the antibody molecule that specifically binds FcγRIIb may be a lama antibody, and in particular a lama hclgG. Like all mammals, camelids produce conventional antibodies made of two heavy chains and two light chains bound together with disulphide bonds in a Y shape (IgGi). However, they also produce two unique sub-classes of immunoglobulin G, IgG₂ and IgG₃, also known as heavy chain IgG (hclgG). These antibodies are made of only two heavy chains that lack the CH1 region but still bear an antigen binding domain at their N-terminus called V_(H)H. Conventional Ig requires the association of variable regions from both heavy and light chains to allow a high diversity of antigen-antibody interactions. Although isolated heavy and light chains still show this capacity, they exhibit very low affinity⁴ when compared to paired heavy and light chains. The unique feature of hclgG is the capacity of their monomeric antigen binding regions to bind antigens with specificity, affinity and especially diversity that are comparable to conventional antibodies without the need of pairing with another region.

In some embodiments reduced binding means that the antibody has a 20 fold reduced affinity with regards to binding to FcγRI.

In order to obtain reduced binding of an IgG1 antibody, such as an IgG1 antibody, to an Fc receptor, it is possible to modify the Fc region of the IgG antibody by aglycosylation. Such aglycosylation, for example of an IgG1 antibody, may for example be achieved by an amino acid substitution of the asparagine in position 297 (N297X) in the antibody chain. The substation may be with a glutamine (N297Q), or with an alanine (N297A), or with a glycine (N297G), or with an asparagine (N297D), or by a serine (N297S).

The Fc region may be modified by further substitutions, for example as described by Jacobsen FW et al., JBC 2017, 292, 1865-1875, (see e.g. Table 1). Such additional substitutions include L242C, V259C, A287C, R292C, V302C, L306C, V323C, I332C, and/or K334C. Such modifications also include the following combinations of substitutions in an IgG1:

-   L242C, N297G, K334C, -   A287C, N297G, L306C, -   R292C, N297G, V302C, -   N297G, V323C, I332C, and -   V259C, N297G, L306C.

Alternatively, the carbohydrate in the Fc region can be cleaved enzymatically and/or the cells used for producing the antibody can be grown in media that impairs carbohydrate addition and/or cells engineered to lack the ability to add the sugars can be used for the antibody production, or by production of antibodies in host cells that do not glycosylate or do not functionally glycosylate antibodies e.g. prokaryotes including E.coli, as explained above.

Reduced affinity for Fc gamma receptors can further be achieved through engineering of amino acids in the antibody Fc region (such modifications have previously been described by e.g. Xencor, Macrogenics, and Genentech), or by production of antibodies in host cells that do not glycosylate or does not functionally glycosylate antibodies e.g. prokaryotes including E. coli.

In addition to having reduced binding to Fcγ receptors through the Fc region, it is in some embodiments preferred that the antibody molecule that specifically binds FcγRIIb does not give rise to phosphorylation of FcγRIIb when binding the target. Phosphorylation of the ITIM of FcγRIIb is an inhibitory event that blocks the activity in the immune cell.

Fc gamma receptor expressing immune effector cell refers herein to principally innate effector cells, and includes specifically macrophages, neutrophils, monocytes, natural killer (NK) cells, basophils, eiosinophils, mast cells, and platelets. Cytotoxic T cells and memory T cells do not typically express FcγRs, but may do so in specific circumstances. In some embodiments the immune effector cell is an innate immune effector cell. In some embodiments, the immune effector cell is a macrophage.

Contrary to the antibody molecule that specifically binds FcγRIIb, the antibody molecule that specifically binds to or interacts with a receptor present on a target immune cell, i.e. the second antibody molecule or the immune cell depleting or deactivating antibody molecule, has an Fc region that binds to or interacts with an activating Fcγ receptor in an extent that is not reduced or at least not substantially reduced. The immune cell to which the second antibody molecule, i.e. the immune cell depleting or deactivating antibody molecule, binds is an immune cell that supresses anti-cancer immunity and the binding of the second antibody to that cell causes depletion or deactivation of that immune cell, which could belong to innate (e.g. TAM, TAN or MDSC) or adaptive arms (e.g. T cell) of the immune system.

By depletion of a cell, we refer herein to depletion, deletion or elimination of immune cells through physical clearance of cells. In particular, we refer to depletion of intratumoural immune cells, or depletion of tumour-associated immune cells e.g. those present in tumour draining lymph nodes.

By deactivation of an immune cell, were refer herein to blocked or reduced activity e.g. reduced cytokine, growth factor, arginase or nitric oxide production, In this context, deactivation of an immune cell also encompasses skewing of the immune cells so that its pro-tumour phenotype is altered into an anti-tumour phenotype e.g. by decreased anti-inflammatory cytokine release, decreased release of proangiogenic growth factors, and increased pro-inflammatory cytokine release and increased reactive oxygen species (ROS), phagocytosis or ADCC activity.

How to determine whether or not an antibody is an immune cell depleting or deactivating antibody is explained further below.

The immune cell to which the second antibody molecule specifically binds is an immune cell that supresses anti-cancer immunity. In this context, anti-cancer immunity includes, but is not limited to, induction of adaptive T cell mediated anti-cancer immunity, including generation of memory recall response.

The immune cell to which the second antibody molecule specifically binds can be a regulatory T cell. Regulatory T cells, Treg cells, Tregs or T_(regs), (formerly known as suppressor T cells, sometimes also called suppressive regulatory T cells), are a subpopulation of T cells which are capable of suppressing other immune cells in normal and pathological immune settings. The immune cell to which the second antibody molecule specifically binds can alternatively be a myeloid cell, in particular a tumour-associated myeloid cell. In some embodiments, the tumour-associated myeloid cell is a tumour-associated macrophage, which is sometimes denoted TAM. In some embodiments it is a tumour-associated neutrophil, which is sometimes denoted TAN. In some embodiments it is a dendritic cell. In some embodiments it is a myeloid-derived suppressor cell, which may be of monocytic or granulocytic type.

In addition to binding specifically to a target on the immune cell, the second antibody molecule binds via its Fc region to an activating Fcγ receptor present on the same immune effector cell as the FcγRIIb to which the first antibody molecule binds and/or to an activating Fcγ receptor present on another immune effector cell. In order to be able to bind to an activating Fcγ receptor, the Fc region of the second antibody should at least in some embodiments be glycosylated at position 297. The carbohydrate residue in this position helps binding to Fcγ receptors. In some embodiments it is preferred that these residues are biantennary carbohydrates which contain GInNAc, mannose, with terminal galactose residues and sialic acid. It should contain the CH₂ part of the Fc molecule.

The cancer to be treated or treatable in accordance with the present invention is an FcγRIIb-negative cancer, which means that it is a cancer that does not present any FcγRIIb receptors. This can be tested using anti-FcγRIIB specific antibodies in a variety of methods including immunohistochemistry and flow cytometry such as indicated in Tutt et al J Immunol 2015, 195 (11) 5503-5516.

Antibodies are well known to those skilled in the art of immunology and molecular biology. Typically, an antibody comprises two heavy (H) chains and two light (L) chains. Herein, we sometimes refer to this complete antibody molecule as a full-size or full-length antibody. The antibody's heavy chain comprises one variable domain (VH) and three constant domains (CH1, CH2 and CH3), and the antibody's molecule light chain comprises one variable domain (VL) and one constant domain (CL). The variable domains (sometimes collectively referred to as the Fv region) bind to the antibody's target, or antigen. Each variable domain comprises three loops, referred to as complementary determining regions (CDRs), which are responsible for target binding. The constant domains are not involved directly in binding an antibody to an antigen, but exhibit various effector functions. Depending on the amino acid sequence of the constant region of their heavy chains, antibodies or immunoglobulins can be assigned to different classes. There are five major classes of immunoglobulins: IgA, IgD, IgE, IgG and IgM, and in humans several of these are further divided into subclasses (isotypes), e.g., IgG1, IgG2, IgG3, and IgG4; IgA1 and IgA2.

Another part of an antibody is the Fc region (otherwise known as the fragment crystallisable domain), which comprises two of the constant domains of each of the anti-body's heavy chains. As mentioned above, the Fc region is responsible for interactions between the antibody and Fc receptor.

The term antibody molecule, as used herein, encompasses full-length or full-size antibodies as well as functional fragments of full length antibodies and derivatives of such antibody molecules.

Functional fragments of a full-size antibody have the same antigen binding characteristics as the corresponding full-size antibody and include either the same variable domains (i.e. the VH and VL sequences) and/or the same CDR sequences as the corresponding full-size antibody. That the functional fragment has the same antigen binding characteristics as the corresponding full-size antibody means that it binds to the same epitope on the target as the full-size antibody. Such a functional fragment may correspond to the Fv part of a full-size antibody. Alternatively, such a fragment may be a Fab, also denoted F(ab), which is a monovalent antigen-binding fragment that does not contain a Fc part, or a F(ab′)₂, which is an divalent antigen-binding fragment that contains two antigen-binding Fab parts linked together by disulfide bonds, or a F(ab′), i.e. a monovalent-variant of a F(ab′)2. Such a fragment may also be single chain variable fragment (scFv).

A functional fragment does not always contain all six CDRs of a corresponding full-size antibody. It is appreciated that molecules containing three or fewer CDR regions (in some cases, even just a single CDR or a part thereof) are capable of retaining the antigen-binding activity of the antibody from which the CDR(s) are derived. For example, in Gao et aL, 1994, J. Biol. Chem., 269: 32389-93 it is described that a whole VL chain (including all three CDRs) has a high affinity for its substrate.

Molecules containing two CDR regions are described, for example, by Vaughan & Sollazzo 2001, Combinatorial Chemistry & High Throughput Screening, 4: 417-430. On page 418 (right column—3 Our Strategy for Design) a minibody including only the H1 and H2 CDR hypervariable regions interspersed within framework regions is described.

The minibody is described as being capable of binding to a target. Pessi et al., 1993, Nature, 362: 367-9 and Bianchi et al., 1994, J. Mol. Biol., 236: 649-59 are referenced by Vaughan & Sollazzo and describe the H1 and H2 minibody and its properties in more detail. In Qiu et aL, 2007, Nature Biotechnology, 25:921-9 it is demonstrated that a molecute consisting of two linked CDRs are capable of binding antigen. Quiocho 1993, Nature, 362: 293-4 provides a summary of “minibody” technology. Ladner 2007, Nature Biotechnology, 25:875-7 comments that molecules containing two CDRs are capable of retaining antigen-binding activity.

Antibody molecules containing a single CDR region are described, for example, in Laune et al., 1997, JBC, 272: 30937-44, in which it is demonstrated that a range of hexapeptides derived from a CDR display antigen-binding activity and it is noted that synthetic peptides of a complete, single, CDR display strong binding activity. In Monnet et al., 1999, JBC, 274: 3789-96 it is shown that a range of 12-mer peptides and associated framework regions have antigen-binding activity and it is commented on that a CDR3-like peptide alone is capable of binding antigen. In Heap et al., 2005, J. Gen. Virol., 86: 1791-1800 it is reported that a “micro-antibody” (a molecule containing a single CDR) is capable of binding antigen and it is shown that a cyclic peptide from an anti-HIV antibody has antigen-binding activity and function. In Nicaise et al., 2004, Protein Science, 13:1882-91 it is shown that a single CDR can confer antigen-binding activity and affinity for its lysozyme antigen.

Thus, antibody molecules having five, four, three or fewer CDRs are capable of retaining the antigen binding properties of the full-length antibodies from which they are derived.

The antibody molecule may also be a derivative of a full-length antibody or a fragment of such an antibody. When a derivative is used it should have the same antigen binding characteristics as the corresponding full-length antibody in the sense that it binds to the same epitope on the target as the full-length antibody.

Thus, by the term “antibody molecule”, as used herein, we include all types of antibody molecules and functional fragments thereof and derivatives thereof, including: monoclonal antibodies, polyclonal antibodies, synthetic antibodies, recombinantly produced antibodies, multi-specific antibodies, bi-specific antibodies, human antibodies, antibodies of human origin, humanized antibodies, chimeric antibodies, single chain antibodies, single-chain Fvs (scFv), Fab fragments, F(ab′)₂ fragments, F(ab′) fragments, disulfide-linked Fvs (sdFv), antibody heavy chains, antibody light chains, homo-dimers of antibody heavy chains, homo-dimers of antibody light chains, heterodimers of antibody heavy chains, heterodimers of antibody light chains, antigen binding functional fragments of such homo- and heterodimers.

Further, the term “antibody molecule”, as used herein, includes all classes of antibody molecules and functional fragments, including: IgG, IgG1, IgG2, IgG3, IgG4, IgA, IgM, IgD, and IgE, unless otherwise specified.

In some embodiments, the antibody is a human IgG1. The skilled person will appreciate that the mouse IgG2a and human IgG1 engage with activatory Fc gamma receptors, and share the ability to activate deletion of target cells through activation of activatory Fc gamma receptor bearing immune cells by e.g. ADCP and ADCC. As such, in embodiments where the mouse IgG2a is the preferred isotype for deletion in the mouse, human IgG1 is a preferred isotype for deletion in human in such embodiments.

As outlined above, different types and forms of antibody molecules are encompassed by the invention, and would be known to the person skilled in immunology. It is well known that antibodies used for therapeutic purposes are often modified with additional components which modify the properties of the antibody molecule.

Accordingly, we include that an antibody molecule of the invention or an antibody molecule used in accordance with the invention (for example, a monoclonal antibody molecule, and/or polyclonal antibody molecule, and/or bi-specific antibody molecule) comprises a detectable moiety and/or a cytotoxic moiety.

By “detectable moiety”, we include one or more from the group comprising of: an enzyme; a radioactive atom; a fluorescent moiety; a chemiluminescent moiety; a bioluminescent moiety. The detectable moiety allows the antibody molecule to be visualised in vitro, and/or in vivo, and/or ex vivo.

By “cytotoxic moiety”, we include a radioactive moiety, and/or enzyme, wherein the enzyme is a caspase, and/or toxin, wherein the toxin is a bacterial toxin or a venom; wherein the cytotoxic moiety is capable of inducing cell lysis.

We further include that the antibody molecule may be in an isolated form and/or purified form, and/or may be PEGylated. PEGylation is a method by which polyethylene glycol polymers are added to a molecule such as an antibody molecule or derivative to modify its behaviour, for example to extend its half-life by increasing its hydrodynamic size, preventing renal clearance.

As discussed above, the CDRs of an antibody bind to the antibody target. The assignment of amino acids to each CDR described herein is in accordance with the definitions according to Kabat EA et al. 1991, In “Sequences of Proteins of Immunological Interest” Fifth Edition, NIH Publication No. 91-3242, pp xv-xvii.

As the skilled person would be aware, other methods also exist for assigning amino acids to each CDR. For example, the International ImMunoGeneTics information system (IMGT(R)) (http://www.imgt.org/ and Lefranc and Lefranc “The Immunoglobulin FactsBook” published by Academic Press, 2001).

In a further embodiment, the antibody molecule of the present invention or used according to the invention is an antibody molecule that is capable of competing with the specific antibodies provided herein, for example antibody molecules comprising any of the amino acid sequences set out in for example SEQ ID NOs: 1-194 for binding to the specific target.

By “capable of competing for” we mean that the competing antibody is capable of inhibiting or otherwise interfering, at least in part, with the binding of an antibody molecule as defined herein to the specific target.

For example, such a competing antibody molecule may be capable of inhibiting the binding of an antibody molecule described herein by at least about 10%; for example at least about 20%, or at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 95%, about 100% and/or inhibiting the ability of the antibody described herein to prevent or reduce binding to the specific target by at least about 10%; for example at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 95%, or about 100%.

Competitive binding may be determined by methods well known to those skilled in the art, such as Enzyme-linked immunosorbent assay (ELISA).

ELISA assays can be used to evaluate epitope-modifying or blocking antibodies. Additional methods suitable for identifying competing antibodies are disclosed in Antibodies: A Laboratory Manual, Harlow & Lane, which is incorporated herein by reference (for example, see pages 567 to 569, 574 to 576, 583 and 590 to 612, 1988, CSHL, NY, ISBN 0-87969-314-2).

It is well known that an antibody specifically binds to or interacts with a defined target molecule or antigen. That is to say, the antibody preferentially and selectively binds its target and not a molecule which is not a target.

The targets of the antibodies according to the present invention, or of the antibodies used in accordance with the invention, are expressed on the surface of cells, i.e. they are cell surface antigen, which would include an epitope (otherwise known in this context as a cell surface epitope) for the antibody. Cell surface antigen and epitope are terms that would be readily understood by one skilled in immunology or cell biology.

By “cell surface antigen”, we include that the cell surface antigen is exposed on the extracellular side of the cell membrane, but may only be transiently exposed on the extracellular side of the cell membrane. By “transiently exposed”, we include that the cell surface antigen may be internalized into the cell, or released from the extracellular side of the cell membrane into the extracellular space. The cell surface antigen may be released from the extracellular side of the cell membrane by cleavage, which may be mediated by a protease.

We also include that the cell surface antigen may be connected to the cell membrane, but may only be transiently associated with the cell membrane. By “transiently associated”, we include that the cell surface antigen may be released from the extracellular side of the cell membrane into the extracellular space. The cell surface antigen may be released from the extracellular side of the cell membrane by cleavage, which may be mediated by a protease.

We further include that the cell surface antigen may be a peptide, or a polypeptide, or a carbohydrate, or an oligosaccharide chain, or a lipid; and/or an epitope that is present on a protein, or a glycoprotein, or a lipoprotein.

Methods of assessing protein binding are known to the person skilled in biochemistry and immunology. It would be appreciated by the skilled person that those methods could be used to assess binding of an antibody to a target and/or binding of the Fc region of an antibody to an Fc receptor; as well as the relative strength, or the specificity, or the inhibition, or prevention, or reduction in those interactions. Examples of methods that may be used to assess protein binding are, for example, immunoassays, BlAcore, western blots, radioimmunoassay (RIA) and enzyme-linked immunosorbent assays (ELISAs) (See Fundamental Immunology Second Edition, Raven Press, New York at pages 332-336 (1989) for a discussion regarding antibody specificity).

Accordingly, by “antibody molecule the specifically binds” or “target specific antibody molecule” we include that the antibody molecule specifically binds a target but does not bind to non-target, or binds to a non-target more weakly (such as with a lower affinity) than the target.

We also include the meaning that the antibody specifically binds to the target at least two-fold more strongly, or at least five-fold more strongly, or at least 10-fold more strongly, or at least 20-fold more strongly, or at least 50-fold more strongly, or at least 100-fold more strongly, or at least 200-fold more strongly, or at least 500-fold more strongly, or at least than about 1000-fold more strongly than to a non-target.

Additionally, we include the meaning that the antibody specifically binds to the target if it binds to the target with a Kd of at least about 10⁻¹ K_(d), or at least about 10⁻² K_(d), or at least about 10⁻³ K_(d), or at least about 10⁻⁴ K_(d), or at least about 10⁻⁶ K_(d), or at least about 10⁻⁶ K_(d), or at least about 10⁻⁷ K_(d), or at least about 10⁻⁸ K_(d), or at least about 10⁻⁶ K_(d), or at least about 10⁻¹⁰ K_(d), or at least about 10⁻¹¹ K_(d), or at least about 10¹² K_(d), or at least about 10⁻¹³ K_(d), or at least about 10¹⁴ K_(d), or at least about 10⁻¹⁵ K_(d).

As used herein, the term immune cell depleting antibody molecule or immune cell deactivating antibody molecule refers to an antibody molecule that upon administration to a patient specifically binds to a target expressed on the surface of an immune cell, wherein this binding results in depletion or deactivation of the immune cell. In some embodiments, the target is a target that is preferentially expressed on a tumour or in the tumour microenvironment.

To decide whether an antibody molecule is an immune cell depleting antibody molecule in the meaning of the present invention or not, it is possible to use an in vitro antibody-dependent cellular cytotoxicity (ADCC) or antibody-dependent cellular phagocytosis (ADCP) assay. To decide whether an antibody molecule is an immune cell depleting antibody molecule the same assay would be performed in the presence of and without the depleting antibody, which would show whether or not the depleting antibody to be tested is in fact depleting.

An ADCC assay may be done by labelling target cells with calcein AM (acetyl methyl ester), followed by the addition of diluting concentrations of antibody. Target cells is then cocultured with human peripheral blood mononuclear cells (PBMCs) at a 50:1 effector: target (E:T) ratio for 4 h at 37° C. The plate is centrifuged at 400×g for 5 min to pellet the cells, and the supernatant is transferred to a white 96-well plate. Calcein release is measured using a Varioskan (Thermo Scientific) using an excitation wavelength of 485 nm and emission wavelength, 530 nm. The percentage of maximal release is calculated as follows: % max release=(sample/triton treated)*100.

An ADCP assay may be done by labelling target cells with 5 mM carboxyfluorescein succinimidyl ester (CFSE) for 10 min at room temperature before washing in media containing foetal calf serum. CFSE-labelled targets is then opsonized with diluting concentrations of antibody before coculturing at a 1:5 E:T ratio with bone marrow derived macrophages (BMDMs) in 96-well plates for 1 h at 37° C. BMDMs are then labelled with anti-F4/80—allophycocyanin for 15 min at room temperature and washed with PBS twice.

Plates are kept on ice, wells are scraped to collect BMDMs, and phagocytosis is assessed by flow cytometry using a FACSCalibur (BD) to determine the percentage of F4/80+CFSE+ cells within the F4/80+ cell population.

It is also possible to use a method as described by Cleary et al in J Immunol, Apr. 12, 2017, 1601473.

In some embodiments the antibody molecule that specifically binds FcγRIIb is a human antibody.

In some embodiments, the antibody molecule that specifically binds FcγRIIb is an antibody of human origin, i.e. an originally human antibody that has been modified as described herein.

In some embodiments, the antibody molecule that specifically binds FcγRIIb is a humanized antibody, i.e. an originally non-human antibody that has been modified to increase its similarity to a human antibody. The humanized antibodies may, for example, be of murine antibodies or lama antibodies.

In some embodiments, the antibody molecule that specifically binds FcγRIIb comprises the following constant regions (CH and CL):

IgG1-CH [SEQ ID NO: 1] ASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGV HTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEP KSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVS HEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGK EYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLIC LVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRW QQGNVFSCSVMHEALHNHYTQKSLSLSPGK IgG1-CL [SEQ ID NO: 2] QPKAAPSVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADSSPVKA GVETTTPSKQSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVA PTECS

These constant regions (SEQ ID NO: 1 and SEQ ID NO: 2) are of human origin. The Fc region is further modified for reduced binding to Fcγ receptors via its Fc region. As mentioned herein, it is in some embodiments preferred that SEQ ID NO: 1 has been aglycosylated through an N297Q substitution, and the IgG1-CH has then the following CH sequence [SEQ ID NO: 195], with the 297 Q residue is marked in bold:

ASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGV HTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEP KSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVS HEDPEVKFNWYVDGVEVHNAKTKPREEQYQSTYRVVSVLTVLHQDWLNGK EYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTC LVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRW QQGNVFSCSVMHEALHNHYTQKSLSLSPGK

In some embodiments and/or examples, murine antibody molecules are used. These may also be used for surrogate antibodies. These may then comprise the following constant regions (CH and CL):

CH [SEQ ID NO: 196] AKTTAPSVYPLAPVCGDTTGSSVTLGCLVKGYFPEPVTLTWNSGSLSSGV HTFPAVLQSDLYTLSSSVTVTSSTWPSQSITCNVAHPASSTKVDKKIEPR GPTIKPCPPCKCPAPNLLGGPSVFIFPPKIKDVLMISLSPIVTCVVVDVS EDDPDVQISWFVNNVEVHTAQTQTHREDYASTLRVVSALPIQHQDWMSGK EFKCKVNNKDLPAPIERTISKPKGSVRAPQVYVLPPPEEEMTKKQVTLTC MVTDFMPEDIYVEWTNNGKTELNYKNTEPVLDSDGSYFMYSKLRVEKKNW VERNSYSCSVVHEGLHNHHTTKSFSRTPGK CL [SEQ ID NO: 197] QPKSSPSVTLFPPSSEELETNKATLVCTITDFYPGVVTVDWKVDGTPVTQ GMETTQPSKQSNNKYMASSYLTLTARAWERHSSYSCQVTHEGHTVEKSLS RADCS

These constant regions (SEQ ID NO: 196 and SEQ ID NO: 197) are thus of murine origin. SEQ ID NO: 196 comprises the N297A mutation (the 297 A residue is marked in bold in the sequence above). This N297A mutation in the murine sequence corresponds to the N297Q mutation in the human sequence.

In some embodiments, the antibody molecule that specifically binds FcγRIIb comprises one or more sequences of the following clones:

Antibody clone: 1A01 1A01-VH [SEQ ID NO: 3] EVQLLESGGGLVQPGGSLRLSCAASGFTFSDYYMNWIRQTPGKGLEWVSL IGWDGGSTYYADSVKGRFTISRDNSENTLYLQMNSLRAEDTAVYYCARAY SGYELDYWGQGTLVTVSS 1A01-VL [SEQ ID NO: 27] QSVLTQPPSASGTPGQRVTISCSGSSSNIGNNAVNWYQQLPGTAPKLLIY DNNNRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNASI FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 51] DYYMN CDRH2: [SEQ ID NO: 52] LIGWDGGSTYYADSVKG CDRH3: [SEQ ID NO: 53] AYSGYELDY CDRL1: [SEQ ID NO: 54] SGSSSNIGNNAVN CDRL2: [SEQ ID NO: 55] DNNNRPS CDRL3: [SEQ ID NO: 56] AAWDDSLNASI Antibody clone: 1B07 1B07-VH [SEQ ID NO: 4] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAF TRYDGSNKYYADSVRGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAREN IDAFDVWGQGTLVTVSS 1B07-VL [SEQ ID NO: 28] QSVLTQPPSASGTPGQRVTISCSGSSSNIGNNAVNWYQQLPGTAPKLLIY DNQQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCEAWDDRLFGPV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 57] SYGMH CDRH2: [SEQ ID NO: 58] FTRYDGSNKYYADSVRG CDRH3: [SEQ ID NO: 59] ENIDAFDV CDRL1: [SEQ ID NO: 60] SGSSSNIGNNAVN CDRL2: [SEQ ID NO: 61] DNQQRPS CDRL3: [SEQ ID NO: 62] WDDRLFGPV Antibody clone: 1C04 1C04-VH [SEQ ID NO: 5] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYAMSWVRQAPGKGLEWVSS ISDSGAGRYYADSVEGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARTH DSGELLDAFDIWGQGTLVTVSS 1C04-VL [SEQ ID NO: 29] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNHVLWYQQLPGTAPKLLIY GNSNRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGWV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 63] SYAMS CDRH2: [SEQ ID NO: 64] SISDSGAGRYYADSVEG CDRH3: [SEQ ID NO: 65] THDSGELLDAFDI CDRL1: [SEQ ID NO: 66] SGSSSNIGSNHVL CDRL2: [SEQ ID NO: 67] GNSNRPS CDRL3: [SEQ ID NO: 68] AAWDDSLNGWV Antibody clone: 1E05 1E05-VH [SEQ ID NO: 6] EVQLLESGGGLVQPGGSLRLSCAASGFTFSTYAMNWVRQVPGKGLEWVAV ISYDGSNKNYVDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARNF DNSGYAIPDAFDIWGQGTLVTVSS 1E05-VL [SEQ ID NO: 30] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YDNNSRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWIDDSLGG PVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 69] TYAMN CDRH2: [SEQ ID NO: 70] VISYDGSNKNYVDSVKG CDRH3: [SEQ ID NO: 71] NFDNSGYAIPDAFDI CDRL1: [SEQ ID NO: 72] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 73] DNNSRPS CDRL3: [SEQ ID NO: 74] AAWDDSLGGPV Antibody clone: 2A09 2A09-VH [SEQ ID NO: 7] EVQLLESGGGLVQPGGSLRLSCAASGFTFSNAWMSWVRQAPGKGLEWVAY ISRDADITHYPASVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCTTGF DYAGDDAFDIWGQGTLVTVSS 2A09-VL [SEQ ID NO: 31] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNAVNWYQQLPGTAPKLLIY GNSDRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGRW VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 75] NAWMS CDRH2: [SEQ ID NO: 76] YISRDADITHYPASVKG CDRH3: [SEQ ID NO: 77] GFDYAGDDAFDI CDRL1: [SEQ ID NO: 78] SGSSSNIGSNAVN CDRL2: [SEQ ID NO: 79] GNSDRPS CDRL3: [SEQ ID NO: 80] AAWDDSLNGRWV Antibody clone: 2B08 2B08-VH [SEQ ID NO: 8] EVQLLESGGGLVQPGGSLRLSCAASGFTFSDYYMSWVRQAPGKGLEWVAL IGHDGNNKYYLDSLEGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARAT DSGYDLLYWGQGTLVTVSS 2B08-VL [SEQ ID NO: 32] QSVLTQPPSASGTPGQRVTISCSGSSSNIGNNAVNWYQQLPGTAPKLLIY YDDLLPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCTTWDDSLSGVV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 81] DYYMS CDRH2: [SEQ ID NO: 82] LIGHDGNNKYYLDSLEG CDRH3: [SEQ ID NO: 83] ATDSGYDLLY CDRL1: [SEQ ID NO: 84] SGSSSNIGNNAVN CDRL2: [SEQ ID NO: 85] YDDLLPS CDRL3: [SEQ ID NO: 86] TTWDDSLSGVV Antibody clone: 2E8-VH 2E8-VH [SEQ ID NO: 9] EVQLLESGGGLVQPGGSLRLSCAASGFTFSDYYMSWIRQAPGKGLEWVSA IGFSDDNTYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAGGD GSGWSFWGQGTLVTVSS 2E8-VL [SEQ ID NO: 33] QSVLTQPPSASGTPGQRVTISCSGSSSNIGNNAVNWYQQLPGTAPKLLIY DNNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCATWDDSLRGWV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 87] DYYMS CDRH2: [SEQ ID NO: 88] AIGFSDDNTYYADSVKG CDRH3: [SEQ ID NO: 89] GDGSGWSF CDRL1: [SEQ ID NO: 90] SGSSSNIGNNAVN CDRL2: [SEQ ID NO: 91] DNNKRPS CDRL3: [SEQ ID NO: 92] ATWDDSLRGWV Antibody clone: 5C04 5C04-VH [SEQ ID NO: 10] EVQLLESGGGLVQPGGSLRLSCAASGFTFSNYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAREW RDAFDIWGQGTLVTVSS 5C04-VL [SEQ ID NO: 34] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YSDNQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLSGS WVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 93] NYGMH CDRH2: [SEQ ID NO: 94] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 95] WRDAFDI CDRL1: [SEQ ID NO: 96] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 97] SDNQRPS CDRL3: [SEQ ID NO: 98] AAWDDSLSGSWV Antibody clone: 5C05 5C05-VH [SEQ ID NO: 11] EVQLLESGGGLVQPGGSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAREN FDAFDVWGQGTLVTVSS 5C05-VL [SEQ ID NO: 35] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YSNSQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGQ VVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 99] TYGMH CDRH2: [SEQ ID NO: 100] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 101] ENFDAFDV CDRL1: [SEQ ID NO: 102] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 103] SNSQRPS CDRL3: [SEQ ID NO: 104] AAWDDSLNGQVV Antibody clone: 5D07 5D07-VH [SEQ ID NO: 12] EVQLLESGGGLVQPGGSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVAV IAYDGSKKDYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAREY RDAFDIWGQGTLVTVSS 5D07-VL [SEQ ID NO: 36] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YGNSNRPSGVPDRFSGSKSGTTASLAISGLRSEDEADYYCAAWDDSVSGW MFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 105] TYGMH CDRH2: [SEQ ID NO: 106] VIAYDGSKKDYADSVKG CDRH3: [SEQ ID NO: 107] EYRDAFDI CDRL1: [SEQ ID NO: 108] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 109] GNSNRPS CDRL3: [SEQ ID NO: 110] AAWDDSVSGWM Antibody clone: 5E12 5E12-VH [SEQ ID NO: 13] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV ISYDGINKDYADSMKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARER KDAFDIWGQGTLVTVSS 5E12-VL [SEQ ID NO: 37] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YSNNQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCATWDDSLNGL VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 111] SYGMH CDRH2: [SEQ ID NO: 112] VISYDGINKDYADSMKG CDRH3: [SEQ ID NO: 113] ERKDAFDI CDRL1: [SEQ ID NO: 114] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 115] SNNQRPS CDRL3: [SEQ ID NO: 116] ATWDDSLNGLV Antibody clone: 5G08 5G08-VH [SEQ ID NO: 14] EVQLLESGGGLVQPGGSLRLSCAASGFTFNNYGMHWVRQAPGKGLEWVAV ISYDGSNRYYADSVKGRFTMSRDNSKNTLYLQMNSLRAEDTAVYYCARDR WNGMDVWGQGTLVTVSS 5G08-VL [SEQ ID NO: 38] QSVLTQPPSASGTPGQRVTISCSGSSSNIGAGYDVHWYQQLPGTAPKLLI YANNQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGP WVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 117] NYGMH CDRH2: [SEQ ID NO: 118] VISYDGSNRYYADSVKG CDRH3: [SEQ ID NO: 119] DRWNGMDV CDRL1: [SEQ ID NO: 120] SGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 121] ANNQRPS CDRL3: [SEQ ID NO: 122] AAWDDSLNGPWV Antibody clone: 5H06 5H06-VH [SEQ ID NO: 15] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV ISYDGSDTAYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARDH SVIGAFDIWGQGTLVTVSS 5H06-VL [SEQ ID NO: 39] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNTVNWYQQLPGTAPKLLIY DNNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEEADYYCSSYAGSNNVV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 123] SYGMH CDRH2: [SEQ ID NO: 124] VISYDGSDTAYADSVKG CDRH3: [SEQ ID NO: 125] DHSVIGAFDI CDRL1: [SEQ ID NO: 126] SGSSSNIGSNTVN CDRL2: [SEQ ID NO: 127] DNNKRPS CDRL3: [SEQ ID NO: 128] SSYAGSNNVV Antibody clone: 6A09 6A09-VH [SEQ ID NO: 16] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV TSYDIGNTKYYANSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARE DCGGDCFDYWGQGTLVTVSS 6A09-VL [SEQ ID NO: 40] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YGNSNRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNEG VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 129] SYGMH CDRH2: [SEQ ID NO: 130] VTSYDGNTKYYANSVKG CDRH3: [SEQ ID NO: 131] EDCGGDCFDY CDRL1: [SEQ ID NO: 132] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 133] GNSNRPS CDRL3: [SEQ ID NO: 134] AAWDDSLNEGV Antibody clone: 6B01 6B01-VH [SEQ ID NO: 17] EVQLLESGGGLVQPGGSLRLSCAASGFTFSNYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARDQ LGEAFDIWGQGTLVTVSS 6B01-VL [SEQ ID NO: 41] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YDNNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCATWDDSLSGP VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 135] NYGMH CDRH2: [SEQ ID NO: 136] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 137] DQLGEAFDI CDRL1: [SEQ ID NO: 138] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 139] DNNKRPS CDRL3 [SEQ ID NO: 140] ATWDDSLSGPV Antibody clone: 6C11 6C11-VH [SEQ ID NO: 18] EVQLLESGGGLVQPGGSLRLSCAASGFTFDDYGMSWVRQAPGKGLEWVSA ISGSGSSTYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAGGD IDYFDYWGQGTLVTVSS 6C11-VL [SEQ ID NO: 42] QSVLTQPPSASGTPGQRVTISCTGSSSNFGAGYDVHWYQQLPGTAPKLLI YENNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGP VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 141] DYGMS CDRH2: [SEQ ID NO: 142] AISGSGSSTYYADSVKG CDRH3: [SEQ ID NO: 143] GDIDYFDY CDRL1: [SEQ ID NO: 144] TGSSSNFGAGYDVH CDRL2: [SEQ ID NO: 145] ENNKRPS CDRL3: [SEQ ID NO: 146] AAWDDSLNGPV Antibody clone: 6C12 6C12-VH [SEQ ID NO: 19] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARER RDAFDIWGQGTLVTVSS 6C12-VL [SEQ ID NO: 43] QSVLTQPPSASGTPGQRVTISCIGSSSNIGAGYDVHWYQQLPGTAPKLLI YSDNQRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCATWDSDTPVF GGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 147] SYGMH CDRH2: [SEQ ID NO: 148] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 149] ERRDAFDI CDRL1: [SEQ ID NO: 150] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 151] SDNQRPS CDRL3: [SEQ ID NO: 152] ATWDSDTPV Antibody clone: 6D01 6D01-VH [SEQ ID NO: 20] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAMYYCARDH SAAGYFDYWGQGTLVTVSS 6D01-VL [SEQ ID NO: 44] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNTVNWYQQLPGTAPKLLIY GNSIRPSGGPDRFSGSKSGTSASLAISGLRSEDEADYYCASWDDSLSSPV FGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 153] SYGMH CDRH2: [SEQ ID NO: 154] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 155] DHSAAGYFDY CDRL1: [SEQ ID NO: 156] SGSSSNIGSNTVN CDRL2: [SEQ ID NO: 157] GNSIRPS CDRL3: [SEQ ID NO: 158] ASWDDSLSSPV Antibody clone: 6G03 6G03-VH [SEQ ID NO: 21] EVQLLESGGGLVQPGGSLRLSCAASGFTFGSYGMHWVRQAPGKGLEWVSG ISWDSAIIDYAGSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAKDE AAAGAFDIWGQGTLVTVSS 6G03-VL [SEQ ID NO: 45] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YGNTDRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLSGP VVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 159] SYGMH CDRH2: [SEQ ID NO: 160] GISWDSAIIDYAGSVKG CDRH3: [SEQ ID NO: 161] DEAAAGAFDI CDRL1: [SEQ ID NO: 162] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 163] GNTDRPS CDRL3: [SEQ ID NO: 164] AAWDDSLSGPVV Antibody clone: 6G08 6G08-VH [SEQ ID NO: 22] EVQLLESGGGLVQPGGSLRLSCAASGFTLSSYGISWVRQAPGKGLEWVSG ISGSGGNTYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCASSV GAYANDAFDIWGQGTLVTVSS 6G08-VL [SEQ ID NO: 46] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YGDTNRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCAAWDDSLNGP VFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 165] SYGIS CDRH2: [SEQ ID NO: 166] GISGSGGNTYYADSVKG CDRH3: [SEQ ID NO: 167] SVGAYANDAFDI CDRL1: [SEQ ID NO: 168] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 169] GDTNRPS CDRL3: [SEQ ID NO: 170] AAWDDSLNGPV Antibody clone: 6G11 6G11-VH [SEQ ID NO: 23] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWMAV ISYDGSNKYYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAREL YDAFDIWGQGTLVTVSS 6G11-VL [SEQ ID NO: 47] QSVLTQPPSASGTPGQRVTISCTGSSSNIGAGYDVHWYQQLPGTAPKLLI YADDHRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCASWDDSQRAV IFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 171] SYGMH CDRH2: [SEQ ID NO: 172] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 173] ELYDAFDI CDRL1: [SEQ ID NO: 174] TGSSSNIGAGYDVH CDRL2: [SEQ ID NO: 175] ADDHRPS CDRL3: [SEQ ID NO: 176] ASWDDSQRAVI Antibody clone: 6H08 6H08-VH [SEQ ID NO: 24] EVQLLESGGGLVQPGGSLRLSCAASGFTFNNYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISKDNSKNTLYLQMNSLRAEDTAVYYCAREY KDAFDIWGQGTLVTVSS 6H08-VL [SEQ ID NO: 48] QSVLTQPPSASGTPGQRVTISCTGSSSNIGSNTVNWYQQLPGTAPKLLIY DNNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCQAWGTGIRVFG GGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 177] NYGMH CDRH2: [SEQ ID NO: 178] VISYDGSNKYYAD SVKG CDRH3: [SEQ ID NO: 179] EYKDAFDI CDRL1: [SEQ ID NO: 180] TGSSSNIGSNTVN CDRL2: [SEQ ID NO: 181] DNNKRPS CDRL3: [SEQ ID NO: 182] QAWGTGIRV Antibody clone: 7C07 7C07-VH [SEQ ID NO: 25] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYGMHWVRQAPGKGLEWVAV ISYDGSNKYYADSVKGRFTISRDNSQNTLYLQMNSLRAEDTAVYYCAREF GYIILDYWGQGTLVTVSS 7C07-VL [SEQ ID NO: 49] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNTVNWYQQLPGTAPKLLI YRDYERPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCMAWDDSLSG VVFGGGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 183] SYGMH CDRH2: [SEQ ID NO: 184] VISYDGSNKYYADSVKG CDRH3: [SEQ ID NO: 185] EFGYIILDY CDRL1: [SEQ ID NO: 186] SGSSSNIGSNTVN CDRL2: [SEQ ID NO: 187] RDYERPS CDRL3: [SEQ ID NO: 188] MAWDDSLSGVV Antibody clone: 4B02 4B02-VH [SEQ ID NO: 26] EVQLLESGGGLVQPGGSLRLSCAASGFTFSNHGMHWVRQAPGKGLEWVAV ISYDGTNKYYADSVRGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARET WDAFDVWGQGTLVTVSS 4B02-VL [SEQ ID NO: 50] QSVLTQPPSASGTPGQRVTISCSGSSSNIGSNNANWYQQLPGTAPKLLIY DNNKRPSGVPDRFSGSKSGTSASLAISGLRSEDEADYYCQAWDSSTVVFG GGTKLTVLG CDR regions CDRH1: [SEQ ID NO: 189] NHGMH CDRH2: [SEQ ID NO: 190] VISYDGTNKYYADSVRG CDRH3: [SEQ ID NO: 191] ETWDAFDV CDRL1: [SEQ ID NO: 192] SGSSSNIGSNNAN CDRL2 [SEQ ID NO: 193] DNNKRPS CDRL3: [SEQ ID NO: 194] QAWDSSTVV

In some embodiments, which are sometimes preferred embodiments, the antibody molecule that specifically binds FcγRIIb comprises the following CDR regions: SEQ ID NO: 171 (CDRH1), SEQ ID NO: 172 (CDRH2), SEQ ID NO: 173 (CDRH3), SEQ ID NO: 174 (CDRL1), SEQ ID NO: 175 (CDRL2) and SEQ ID NO: 176 (CDRL3), i.e. the CDR regions of clone 6G11.

In some embodiments, which are sometimes preferred embodiments, the antibody molecule that specifically binds FcγRIIb comprises the following constant regions: SEQ ID NO: 1 (CH) and SEQ ID NO: 2 (CL) and the following variable regions: SEQ ID NO: 23 (VL) and SEQ ID NO: 47 (VH) i.e. the constant and variable regions of clone 6G11, which antibody molecule has further been modified to have reduced binding to Fcγ receptors via its Fc region. In some embodiments, which are sometimes preferred embodiments, the antibody molecule that specifically binds FcγRIIb comprises the following constant regions: SEQ ID NO: 195 (CH) and SEQ ID NO: 2 (CL) and the following variable regions: SEQ ID NO: 23 (VL) and SEQ ID NO: 47 (VH) i.e. the constant and variable regions of clone 6G11 including the N297Q mutation.

In some embodiments, the immune cell depleting or deactivating antibody molecule is a human antibody molecule or an antibody molecule of human origin. In some such embodiments, the human antibody molecule or antibody molecule of human origin is an IgG antibody. In some such embodiments the human antibody molecule or antibody molecule of human origin is an IgG1 or an IgG2 antibody.

In some embodiments, the immune cell depleting or deactivating antibody molecule is a humanized antibody molecule.

In some embodiments the immune cell depleting or deactivating antibody molecule is a chimeric antibody.

As mentioned above, the immune cell depleting or deactivating antibody must have the ability to engage FcγRs.

The target that immune cell depleting or deactivating antibody molecule in accordance with the present invention binds to may be selected from the group consisting CTLA-4, 4-1BB, OX40, TNFR2, PD-L1, IL-2R, and GITR. In some embodiments of the present invention, the target that immune cell depleting or deactivating antibody molecule in accordance with the present invention binds to is CTLA-4. CTLA-4, or CTLA4, which stands for cytotoxic T-lymphocyte-associate protein 4, is also known as CD152. It is a protein receptor, that functioning as an immune checkpoint, downregulates immune responsive. CTLA4 is constitutively expressed in regulatory T cells but only upregulated in conventional T cells after activation—a phenomenon which is particularly notable in cancers. In some such embodiments the immune cell depleting antibody molecule is ipilimumab (such as Yervoy® from Bristol-Myers Squibb). In some such embodiments the immune cell depleting antibody molecule is tremelimumab (formerly denoted ticilimumab and, CP-675,206), which is a fully human monoclonal antibody against CTLA-4.previously in development by Pfizer and now in clinical development by MedImmune.

In some embodiments of the present invention, at least one target is 4-1BB, which is also denoted CD137 and tumour necrosis factor receptor superfamily member 9 (TNFRSF9). 4-1BB is expressed on Tregs following activation of CD4+ and CD8+ T cells and its ligation is required for optimal protective CD8 T cell responses against viruses and B cell lymphoma in mice. Anti-4-1BB specific antibodies enhance the proliferation and survival of antigen-stimulated T cells in vitro and, similar to anti-CD40, anti-4-1BB mAb promote anti-tumour immunity in pre-clinical cancer models dependent largely on CD8 T cells. In some such embodiments the immune cell depleting antibody molecule is urelumab, a humanized agonistic IgG4 monoclonal antibody developed by Bristol-Myers Squibb. In some such embodiments the immune cell depleting antibody molecule is utomilumab.(also denoted (PF-05082566, PF-2566, and PF-5082566), a human HuCAL mAb agonist of 4-1BB developed by Pfizer.

In some embodiments of the present invention, at least one target is OX40. OX40, also known as tumour necrosis factor receptor superfamily, member 4 (TNFRSF4), and CD134, is a secondary co-stimulatory immune checkpoint molecule. In some such embodiments the immune cell depleting antibody molecule is MEDI6469 (9B12), MEDI0562, PF-04518600, INCAGN01949, BMS-986178, MOXR0916, GSK3174998, MEDI6383 (see e.g. Table 1 of Buchan et al., Blood 2018 131:39-48).

In some embodiments of the present invention, at least one target is TNFR-2. Tumour necrosis factor receptor 2 (TNFR-2 or TNFR2), also known as tumour necrosis factor receptor superfamily member 1B (TNFRSF1B) and CD120b, which is a membrane receptor that binds tumour necrosis factor-alpha (TNFα).

In some embodiments of the present invention, the target that immune cell depleting or deactivating antibody molecule in accordance with the present invention binds to is programmed death-ligand 1 (PD-L1), also known as CD274 or B7 homolog 1 (B7-H1).

In some embodiments of the present invention, at least one target is IL-2R. IL-2R is also known as CD25 and is highly expressed primarily on regulatory T cells.

In some embodiments of the present invention, at least one target is GITR. GITR is a member of the TNFSFR and is also primarily expressed on regulatory T cells.

In some embodiments the antibody molecule that specifically binds FcγRIIb and the immune cell depleting or deactivating antibody molecule are administered simultaneously to the patient, meaning that they are either administered together at one or separately very close in time to each other.

In some embodiments the antibody molecule that specifically binds FcγRIIb is administered to the patient prior to administration of the immune cell depleting or deactivating antibody molecule. Such sequential administration may be achieved by temporal separation of the two antibodies. Alternatively, or in combination with the first option, the sequential administration may also be achieved by spatial separation of the two antibody molecules, by administration of the antibody molecule that specifically binds FcγRIIb in a way, such as intratumoural, so that it reaches the cancer prior to the immune cell depleting antibody molecule, which is then administered in a way, such as systemically, so that it reaches the cancer after the antibody molecule that specifically binds FcγRIIb.

In some embodiments the immune cell depleting antibody is administered to the patient prior to administration of the antibody molecule that specifically binds FcγRIIb. Such sequential administration may be achieved as described above.

It would be known to the person skilled in medicine, that medicines can be modified with different additives, for example to change the rate in which the medicine is absorbed by the body; and can be modified in different forms, for example to allow for a particular administration route to the body.

Accordingly, we include that the composition, and/or antibody, and/or medicament of the invention may be combined with an excipient and/or a pharmaceutically acceptable carrier and/or a pharmaceutically acceptable diluent and/or an adjuvant.

We also include that the composition, and/or antibody, and/or medicament of the invention may be suitable for parenteral administration including aqueous and/or non-aqueous sterile injection solutions which may contain anti-oxidants, and/or buffers, and/or bacteriostats, and/or solutes which render the formulation isotonic with the blood of the intended recipient; and/or aqueous and/or non-aqueous sterile suspensions which may include suspending agents and/or thickening agents. The composition, and/or antibody, and/or agent, and/or medicament of the invention may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (i.e. lyophilised) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.

Extemporaneous injection solutions and suspensions may be prepared from sterile powders, and/or granules, and/or tablets of the kind previously described.

For parenteral administration to human patients, the daily dosage level of the antibody molecule that specifically binds FcγRIIb and/or the immune cell depleting or deactivating antibody molecule will usually be from 1 mg/kg bodyweight of the patient to 20 mg/kg, or in some cases even up to 100 mg/kg administered in single or divided doses. Lower doses may be used in special circumstances, for example in combination with prolonged administration. The physician in any event will determine the actual dosage which will be most suitable for any individual patient and it will vary with the age, weight and response of the particular patient. The above dosages are exemplary of the average case. There can, of course, be individual instances where higher or lower dosage ranges are merited and such are within the scope of this invention.

Typically, the composition and/or medicament of the invention will contain the antibody molecule that specifically binds FcγRIIb and/or the immune cell depleting or deactivating antibody at a concentration of between approximately 2 mg/ml and 150 mg/ml or between approximately 2 mg/mI and 200 mg/ml. In a preferred embodiment, the medicaments and/or compositions of the invention will contain the antibody molecule that specifically binds FcγRIIb and/or the immune cell depleting or deactivating antibody molecule at a concentration of 10 mg/ml.

Generally, in humans, oral or parenteral administration of the composition, and/or antibody, and/or agent, and/or medicament of the invention is the preferred route, being the most convenient. For veterinary use, the composition, and/or antibody, and/or agent and/or medicament of the invention are administered as a suitably acceptable formulation in accordance with normal veterinary practice and the veterinary surgeon will determine the dosing regimen and route of administration which will be most appropriate for a particular animal. Thus, the present invention provides a pharmaceutical formulation comprising an amount of an antibody and/or agent of the invention effective to treat various conditions (as described above and further below). Preferably, the composition, and/or antibody, and/or agent, and/or medicament is adapted for delivery by a route selected from the group comprising: intravenous (IV); subcutaneous (SC), intramuscular (IM), or intratumoural.

In some embodiments, either the first antibody molecule or the second antibody or both may be administered through the use of plasmids or viruses. Such plasmids then comprise nucleotide sequences encoding either the first antibody molecule or the second antibody or both. In some embodiments, nucleotide sequences encoding parts of or the full sequences of either the first antibody molecule or the second antibody or both integrated in a cell or viral genome or in a viriome in a virus; such a cell or virus then act as a delivery vehicle for either the first antibody molecule or the second antibody or both (or a delivery vehicle for a nucleotide sequence encoding either the first antibody molecule or the second antibody or both). For example, in some embodiments, such a virus may be in the form of a therapeutic oncolytic virus comprising nucleotide sequences encoding at least one of the antibody molecules described herein. In some embodiments, such an oncolytic virus comprises nucleotide sequences encoding a full-length human IgG antibody. Oncolytic viruses are known to those skilled in the arts of medicine and virology.

The present invention also includes composition, and/or antibody, and/or agent, and/or medicament comprising pharmaceutically acceptable acid or base addition salts of the polypeptide binding moieties of the present invention. The acids which are used to prepare the pharmaceutically acceptable acid addition salts of the aforementioned base compounds useful in this invention are those which form non-toxic acid addition salts, i.e. salts containing pharmacologically acceptable anions, such as the hydrochloride, hydrobromide, hydroiodide, nitrate, sulphate, bisulphate, phosphate, acid phosphate, acetate, lactate, citrate, acid citrate, tartrate, bitartrate, succinate, maleate, fumarate, gluconate, saccharate, benzoate, methanesulphonate, ethanesulphonate, benzenesulphonate, p-toluenesulphonate and pamoate [i.e. 1,1-methylene-bis-(2-hydroxy-3 naphthoate)] salts, among others. Pharmaceutically acceptable base addition salts may also be used to produce pharmaceutically acceptable salt forms of the agents according to the present invention. The chemical bases that may be used as reagents to prepare pharmaceutically acceptable base salts of the present agents that are acidic in nature are those that form non-toxic base salts with such compounds. Such non-toxic base salts include, but are not limited to those derived from such pharmacologically acceptable cations such as alkali metal cations (e.g. potassium and sodium) and alkaline earth metal cations (e.g. calcium and magnesium), ammonium or water-soluble amine addition salts such as N-methylglucamine-(meglumine), and the lower alkanolammonium and other base salts of pharmaceutically acceptable organic amines, among others. The agents and/or polypeptide binding moieties of the invention may be lyophilised for storage and reconstituted in a suitable carrier prior to use. Any suitable lyophilisation method (e.g. spray drying, cake drying) and/or reconstitution techniques can be employed. It will be appreciated by those skilled in the art that lyophilisation and reconstitution can lead to varying degrees of antibody activity loss (e.g. with conventional immunoglobulins, IgM antibodies tend to have io greater activity loss than IgG antibodies) and that use levels may have to be adjusted upward to compensate. In one embodiment, the lyophilised (freeze dried) polypeptide binding moiety loses no more than about 20%, or no more than about 25%, or no more than about 30%, or no more than about 35%, or no more than about 40%, or no more than about 45%, or no more than about 50% of its activity (prior to lyophilisation) when re-hydrated.

The combination of an antibody molecule that specifically binds FcγRIIb and an immune cell depleting or deactivating antibody molecule can be used use in the treatment of cancer.

“Patient” as the term is used herein refers to an animal, including human, that has been diagnosed as having an FcγRIIb negative cancer or as having a cancer that is considered as likely to be FcγRIIb negative cancer and/or that exhibits symptoms of such a cancer.

We include that the patient could be mammalian or non-mammalian. Preferably, the patient is a human or is a mammalian, such as a horse, or a cow, or a sheep, or a pig, or a camel, or a dog, or a cat. Most preferably, the mammalian patient is a human.

By “exhibit”, we include that the subject displays a cancer symptom and/or a cancer diagnostic marker, and/or the cancer symptom and/or a cancer diagnostic marker can be measured, and/or assessed, and/or quantified.

It would be readily apparent to the person skilled in medicine what the cancer symptoms and cancer diagnostic markers would be and how to measure and/or assess and/or quantify whether there is a reduction or increase in the severity of the cancer symptoms, or a reduction or increase in the cancer diagnostic markers; as well as how those cancer symptoms and/or cancer diagnostic markers could be used to form a prognosis for the cancer.

Cancer treatments are often administered as a course of treatment, which is to say that the therapeutic agent is administered over a period of time. The length of time of the course of treatment will depend on a number of factors, which could include the type of therapeutic agent being administered, the type of cancer being treated, the severity of the cancer being treated, and the age and health of the patient, amongst others reasons.

By “during the treatment”, we include that the patient is currently receiving a course of treatment, and/or receiving a therapeutic agent, and/or receiving a course of a therapeutic agent.

In some embodiments the FcγRIIb negative cancer to be treated in accordance with the present invention is a solid cancer.

In some embodiments, the cancer is selected from the group consisting of carcinomas, sarcomas, and lymphomas.

In some embodiments, the cancer is a carcinoma selected from the group consisting of adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, anaplastic or undifferentiated carcinoma, large cell carcinoma and small cell carcinoma.

In some embodiments, the cancer is a sarcoma selected from the group consisting of osteosarcoma, chondrosarcoma, liposarcoma, and leiomyosarcoma. FcγRIIb negative cancer is selected from the group consisting of melanoma, breast cancer, ovarian cancer, prostate cancer, metastatic hormone-refractory prostate cancer, colonrectal cancer, lung cancer, small cell lung carcinoma (NSCLC), small cell lung cancer (SCLC), non-small cell lung cancer, urothelial carcinoma, bladder cancer, kidney cancer, mesothelioma, Merkel cell carcinoma, and head and neck cancer.

Each one of the above described cancers is well-known, and the symptoms and cancer diagnostic markers are well described, as are the therapeutic agents used to treat those cancers. Accordingly, the symptoms, cancer diagnostic markers, and therapeutic agents used to treat the above mentioned cancer types would be known to those skilled in medicine.

Clinical definitions of the diagnosis, prognosis and progression of a large number of cancers rely on certain classifications known as staging. Those staging systems act to collate a number of different cancer diagnostic markers and cancer symptoms to provide a summary of the diagnosis, and/or prognosis, and/or progression of the cancer. It would be known to the person skilled in oncology how to assess the diagnosis, and/or prognosis, and/or progression of the cancer using a staging system, and which cancer diagnostic markers and cancer symptoms should be used to do so.

By “cancer staging”, we include the Rai staging, which includes stage 0, stage I, stage II, stage III and stage IV, and/or the Binet staging, which includes stage A, stage B and stage C, and/or the Ann Arbour staging, which includes stage I, stage II, stage III and stage IV.

It is known that cancer can cause abnormalities in the morphology of cells. These abnormalities often reproducibly occur in certain cancers, which means that examining these changes in morphology (otherwise known as histological examination) can be used in the diagnosis or prognosis of cancer. Techniques for visualizing samples to examine the morphology of cells, and preparing samples for visualization, are well known in the art; for example, light microscopy or confocal microscopy.

By “histological examination”, we include the presence of small, mature lymphocyte, and/or the presence of small, mature lymphocytes with a narrow border of cytoplasm, the presence of small, mature lymphocytes with a dense nucleus lacking discernible nucleoli, and/or the presence of small, mature lymphocytes with a narrow border of cytoplasm, and with a dense nucleus lacking discernible nucleoli, and/or the presence of atypical cells, and/or cleaved cells, and/or prolymphocytes.

It is well known that cancer is a result of mutations in the DNA of the cell, which can lead to the cell avoiding cell death or uncontrollably proliferating. Therefore, examining these mutations (also known as cytogenetic examination) can be a useful tool for assessing the diagnosis and/or prognosis of a cancer. An example of this is the deletion of the chromosomal location 13q14.1 which is characteristic of chronic lymphocytic leukaemia. Techniques for examining mutations in cells are well known in the art; for example, fluorescence in situ hybridization (FISH).

By “cytogenetic examination”, we include the examination of the DNA in a cell, and, in particular the chromosomes. Cytogenetic examination can be used to identify changes in DNA which may be associated with the presence of a refractory cancer and/or relapsed cancer. Such may include: deletions in the long arm of chromosome 13, and/or the deletion of chromosomal location 13q14.1, and/or trisomy of chromosome 12, and/or deletions in the long arm of chromosome 12, and/or deletions in the long arm of chromosome 11, and/or the deletion of 11q, and/or deletions in the long arm of chromosome 6, and/or the deletion of 6q, and/or deletions in the short arm of chromosome 17, and/or the deletion of 17p, and/or the t(11:14) translocation, and/or the (q13:q32) translocation, and/or antigen gene receptor rearrangements, and/or BCL2 rearrangements, and/or BCL6 rearrangements, and/or t(14:18) translocations, and/or t(11:14) translocations, and/or (q13:q32) translocations, and/or (3:v) translocations, and/or (8:14) translocations, and/or (8:v) translocations, and/or t(11:14) and (q13:q32) translocations.

It is known that patients with cancer exhibit certain physical symptoms, which are often as a result of the burden of the cancer on the body. Those symptoms often reoccur in the same cancer, and so can be characteristic of the diagnosis, and/or prognosis, and/or progression of the disease. A person skilled in medicine would understand which physical symptoms are associated with which cancers, and how assessing those physical systems can correlate to the diagnosis, and/or prognosis, and/or progression of the disease. By “physical symptoms”, we include hepatomegaly, and/or splenomegaly.

BRIEF DESCRIPTION OF THE DRAWINGS

In the examples below, reference is made to the following figures:

FIG. 1 illustrates a potential mechanism explaining why the invention works. The immune cell depleting or deactivating antibody molecule, in this case an anti-CTLA-4 antibody, binds to a receptor present on the immune cell that supresses anti-cancer immunity, in this case a Treg. The Fc region of the anti-CTLA-4 antibody binds to an activating Fcγ receptor, which in this case in present on the surface of a macrophage. In addition, an antibody molecule that specifically binds FcγRIIb, binds to FcγRIIb present on the surface of the macrophage. Since this specific antibody has an Fc region with reduced binding to activating Fcγ receptors, it does not bind to any of the activating Fcy receptors present on the macrophage, which instead are free for binding to the Fc region of the anti-CTLA-4 antibody.

FIG. 1A shows the use of only an anti-CTLA-4 antibody. The anti-CTLA-4 antibody binds to, and thus activates, both activating and inhibitory Fcγ receptors, thus resulting in a weak activation, and thus a reduced effect compared to what the situation had been had the anti-CTLA-4 antibody bound to only activating Fcγ receptors.

FIG. 1B shows that the combination of an anti-CTLA-4 antibody and WT (wild type) FcγRIIb antibody leads to reduced activation. In this case, the FcγRIIb antibody both blocks activating Fcγ receptors and activates inhibitory Fcγ receptors, which is the opposite of the effect desired in accordance with the present invention.

FIG. 1C shows that the combination of an anti-CTLA-4 antibody and an aglycosylated FcγRIIb antibody according to the invention leads to maximum activation. There is no blocking of activating Fcγ receptors and there is no activation of inhibitory Fcγ receptors, leading to maximal deletion of the target. Here aglycoslyated FcγRIIb antibody could be one lacing the Fc domain or with otherwise reduced binding to the FcRs.

FIG. 2 illustrates that FcγRIIB antibodies with impaired Fc binding to activating Fc receptors, but not wild type antibodies with retained binding to activating Fc receptors boost B cell depletion by CD20 mAb.

(FIG. 2A-B) CFSE⁺ hCD20^(+/−)x mFcγRII^(-/-) (target) and mFcγRII^(-/-) (non-target) splenocytes were injected into hFcγRIIB^(+/−)x mFcγRII^(-/-) recipient mice. Mice received WT or N297Q FcγRIIB mAb (6G11) (2×20 mg/kg) followed by Rit (0.2-2 mg/kg) and the ratio of blood (A) and splenic (B) CFSE⁺ CD19⁺ cells determined, as before. Data combined from at least 2 independent experiments. (FIG. 2C) CFSE⁺ hCD20^(+/−)x mFcγRII^(-/-) (target) and mFcγRII^(-/-) (non-target) splenocytes were injected into hFcγRIIB^(+/−)x mFcγRII^(-/-) recipient mice. Mice received WT or N297Q FcγRIIB mAb (6G11) (20 mg/kg) followed by Rit (2 mg/kg) and the expression of activatory mFcγRs was quantified on splenic F4/80+effector cells using indicated mAb. (FIG. 2D-E) Ability of WT and N297Q (NQ) hFcγRIIB specific mAb (6G11; 10 μg/ml for 15 min) to elicit hFcγRIIB ITIM phosphorylation (pFcγRIIB) on (FIG. 2D) mouse BMDMs, and (FIG. 2E) isolated primary peripheral blood monocytes following high density culture, respectively. α-Tubulin, GAPDH and hFcγRIIB were used as loading controls, as indicated; representative blots shown.

FIG. 3 illustrates that WT and FcγR-null FcγRIIB mAb can be combined for optimal depletion of target cells

CFSE+hCD20^(+/−) (target) and mFcγRII^(-/-) (non-target) splenocytes were injected into hFcγRIIB^(+/−) x mFcγRII^(-/-) (Balb/c) recipient mice. Mice received WT (2×10−20 mg/kg) or F(ab′)2 (2×20 mg/kg) mFcγRII (AT130-5) or WT (2×20 mg/kg) or F(ab′)₂ (2×40 mg/kg) hFcγRIIB mAb (AT10) followed by Rit (0.2-2 mg/kg), as indicated on the X axis, and the ratio of splenic CFSE⁺ CD19⁺ cells determined, as before. Data combined from 1-3 independent experiments. Each dot depicts a result from an individual mouse, with mean ratios indicated by the horizontal line. Data analysed using One-way ANOVA.

FIG. 4 shows assessment of Treg deletion with anti-IL2R mAb +/− FcγRIIB blockade with Fc-inert-NA mutant mAb. FIG. 4A) 100 μg AT130-2 NA given by intraperitoneal injection (i.p.) to female Balb/c mice. 100 μg PC61 given i.p 6 hours later. Tregs (FoxP3+) in blood, spleen and lymph nodes determined by FACs 4 days later. Mice were culled and single cell suspensions obtained from the spleen, LN and blood which were stained with antibodies against CD4, CD8 and B220 prior to intracellular FoxP3 staining before being analysed on a FACs canto. The white cell count for each tissue was determined. Tregs were defined as being CD8-CD4+ FoxP3+ and the number of Tregs calculated using the white cell count. FIG. 4B) as above but with C57BU6 mice. FIG. 4C) CD8/Treg ratio calculated from FIG. 4B).

FIG. 5 shows assessment of Treg deletion with anti-IL2R mAb +/− FcγRIIB blockade with wild-type or NA mutant mAb. WT AT130-2 does not appear to give any improvement in deletion; whereas NA variant does. A) 100 μg AT130-2 NA or mIgG1 WT AT130-2 was given i.p. to female Balb/c mice. 100 μg PC61 given i.p 6 hours later. Tregs (FoxP3⁺) in spleen determined by FACs 4 days later. Mice were culled and single cell suspensions obtained from the spleen which was stained with antibodies against CD4, CD8 and B220 prior to intracellular FoxP3 staining before being analysed on a FACs canto. The white cell count for each tissue was determined. Tregs were defined as being CD8-CD4+ FoxP3+ and the number of Tregs calculated using the white cell count. There was a significantly lower number of Tregs in the spleen of mice 4 days receiving the N297A antibody in combination with PC61 compared to a wild-type mIgG1 AT130-2 (unpaired T-test, P=0.044)

FIG. 6 illustrates combination therapy with anti-CTLA-4 and FcγRIIB blockade. 5×10⁵ CT26 cells were injected S.C into female BALB/c mice. Mice were randomised into treatment groups when tumour width x length was approximately 100 mm². Treatment was performed on days 0, 2, 4 and 11. 9H10 (hamster anti-mouse CTLA4) only mice received 200 μg antibody I.P in 200 μl PBS on each day. On day 0 combination mice received 100 μg AT130-2 N297A (anti-mouse CD32) in 200 μl PBS I.P, 6 hours later they received 200 μg 9H10 I.P in 200 μl PBS. On days 2, 4 and 11 combination mice received both antibodies (200 μg 9H10 and 100 μg AT130-2 NA) in a single 200 μl I.P injection. The width and length of tumours was measured and mice were culled when tumour length×width exceeded 400 mm². FIG. 6A) represents the treatment schedule. Group 1: No Ab; Group 2: anti-mCD32 (AT130-2 NA; 100 μg); Group 3: anti-CTLA-4 (9H10; 200 μg); Group 4: combination (PC61) 6 hours after AT130-2. Tumours were allowed to establish and were treated at 100 mm². An extra dose was given on day 12. FIG. 6B) shows growth of the individual tumours. FIG. 6C) represents the mean tumour area +/− SD or SEM. FIG. 6D) represents animal survival. FIG. 6E) Composite from 2 separate experiments (n=10/group) displaying survival and demonstrated that the combination of 9H10 and AT130-2NA (NA combo) is significantly more potent at extending survival than the 9H10 alone (p=0.0179).

FIG. 7 illustrates combination therapy of anti-CTLA-4 and FcγRIIB blockade comparing WT (denoted M1 combo) and Fc-inert (denoted NA combo) AT130-2 mAb. 5×105 CT26 cells injected S.0 into female BALB/c mice. Mice were randomised into treatment groups when tumour width x length was approximately 100 mm². Treatment was performed on days 0, 2, 4 and 11. On day 0 combination mice received 100 μg AT130-2 N297A or AT130-2 mIgG1 (anti-mouse CD32) in 200 μl PBS I.P, 6 hours later they received 200 μg 9H10 I.P in 200 μl PBS. On days 2, 4 and 11 combination mice received both antibodies (200 μg 9H10 and 100 μg AT130-2 NA/mIgG1) in a single 200 μl I.P injection. The width and length of tumours was measured and mice were culled when tumour length x width exceeded 400 mm². Data is shown in the survival curve below N=11-12. There was significantly longer survival in the NA combination treated group compared to mice receiving the mIgG1 combination (log-rank test P=0.0460).

FIG. 8 illustrates combination therapy with anti-PD-L1 and FcγRIIB blockade, and to address whether this effect was dependent upon the NA format of the antibody, the experiment was performed using both WT mIgG1 and the NA format. FIG. 8A shows the growth of individual tumours in each group (one graph per group). The number indicates the number of surviving mice in each group. FIG. 8B shows the survival curves for the mice.

FIG. 9 shows wild-type (top) versus N297A (bottom) formats of the anti-mouse FcγRIIB mAb AT130-2 binding to FcγRs. It shows SPR analysis of AT130-2 in either format binding to the mouse FcγRs indicated (100 nM).

FIG. 10 shows WT 6G11 versus N297A 6G11 binding to Fc gamma receptors (mouse and human). It illustrates SPR analysis of native and N297A anti-huCD32b 6G11 hIgG1 binding to the low affinity human and mouse FcγRs indicated. FIG. 10A and B show results for human FcγR (100 nM). FIG. 10C and D show the results for mouse FcγR (100 nM). FIG. 10E and E show the results for human FcγR (serial increasing additions)—FcγRIIb and hCD64. FIG. 10G and H show the results for mouse FcγR (100 nM), i.e. the same as FIG. c and d but rescaled for clearer view.

EXAMPLES

Specific, non-limiting examples which embody certain aspects of the invention will now be described. To allow for examining the effect of blockade of FcγRIIB in complex in vivo systems, two sets of surrogate antibodies has to be used. The murine equivalent of 6G11 is called AT130-2. To Fc mute a human antibody (hence to render the binding to FcγR's severely impaired or negliable), we have replaced the amino acid position 297 from a N to a Q. To Fc mute a murine antibody, the same position is replaced from and N to an Q. Hence, in a murine system we will refer to AT-130, while this patent application concenrns the human counterpart 6G11 In short, the human 6G11 corresponds to the murine surrogate AT1302-2, while the 6G11-N297A corresponds to the AT130-3-N297A.

A different way to Fc mute an antibody (and well known to those skilled in the art) would be to take away the Fc part and form a Fab or Fab2 fragment,

Experimental Procedures Animals

hCD20 Tg (transgenic), hFcγRIIB^(+/−) and mFcγRIIB^(-/-) mice have been described previously (Beers et al., Blood 2008 Nov. 15; 112(10):4170-7; Roghanian et al, Cancer Cell 27, 473-488, Apr. 13, 2015) with genotypes confirmed by PCR and/or flow cytometry. Mice were bred and maintained in local facilities in accordance with the UK Home Office guidelines or local Swedish Ethical committee.

Cell Culture

Cell culture was performed in supplemented RPMI (RPMI 1640 containing 2 mM glutamine, 1 mM pyruvate, 100 IU/ml penicillin and streptomycin and 10% FCS [Myoclone]) (GIBCO BRL, Paisley, Scotland). Mouse splenic B cells were purified by negative selection using MACS B cell isolation kits (Miltenyi Biotec, UK) and cultured in the same media. Cell-lines were obtained from ECACC and maintained in antibiotic-free supplemented RPMI medium.

Generation of Human Monocyte-Derived Macrophages (MDM) and Mouse Bone Marrow Derived Macrophages (BMDM)

Human MDMs were differentiated from peripheral blood obtained either from the National Blood Service, Southampton General Hospital (Southampton, UK) or from the blood centers in the hospital of Halmstad or Skåne University Hospital (Sweden). Briefly adherent CD14⁺ monocytes were cultured in supplemented RPMI containing 25-100 ng/mL endotoxin-low recombinant human macrophage-colony stimulating factor (M-CSF; R&D Systems, US or produced in-house), as previously described (Roghanian et al., Cell lmmunol. 2010; 265(2):120-6.). Half of the medium was replaced with fresh M-CSF every 2 days until harvest. On day 7-10 of culture, MDMs were harvested following a short incubation with cold PBS.

Mouse BMDMs were generated from cells isolated from the bone marrow of the femur and tibia of mice, as previously reported (Williams et al., J Immunol. 2013 Oct. 15; 191(8):4130-40.). Briefly, bone marrow cells were cultured in supplemented RPMI containing 20% L929 cell—conditioned medium (containing M-CSF). Cells were cultured at 37° C., 5% CO2 for 10-12 days prior to use. Macrophage differentiation was routinely confirmed by morphological examination and/or flow cytometry for CD11b and F4/80 expression.

Antibodies and Reagents

mAb were typically produced from the culture supernatant of hybridoma or stably transfected CHO-k1 cells (obtained from ECACC). F(ab′)₂ fragments were produced as described previously (Glennie et al., 1987). The hFcγRII mAb AT10 was previously described (Greenman et al., 1991). Anti-CTLA4 (9H10; Bio X Cell, US), anti-IL2R (PC-61.5.3; Bio X Cell/in-house), anti-PDL-1 (10F.9G2 Bio X Cell, US). The hFcγRII mAb 6G11 hIgG1 and N297Q were produced by Biolnvent (see Roghanian et al, Cancer Cell 27, 473-488, April 13, 2015). The mFcγRII mAb AT130-2 mIgG1, mlgG2a and mIgG1 N297A were produced in-house. AT130-5 (Williams et al, Eur J Immunol. 2012; 42(8):2109-20, and Tutt et al J Immunol 2015, 195 (11) 5503-5516) is a murine anti-mouse FcγRII antibody similar to the human antibody clone 6G11.). Antibodies against hFcγRIIB (clone EP888Y; Abcam, UK), phosphorylated hFcγRIIB (clone EP926Y; Ori-gene, US), GAPDH (Abcam, UK) and a-tubulin (Cell Signaling, US) were used for immunoblotting. For PBMC immunophenotyping, FcγRIIB mAb labelled with PE using zenon labelling kit (Molecular Probes) was used in conjunction with anti-CD3-FITC, anti-CD19-PerCP-Cy5.5 and anti-CD56-APC (antibodies obtained from Biolegend).

Flow Cytometry

Fluorescently conjugated mAb were purchased from BD Biosciences, eBiosciences, Biolegend, AbD Serotec (all UK) or made in-house. Flow cytometry was performed as described previously (Tutt et al., 1998) with samples assessed on a FACScan, FACSCalibur or FACSCanto II with data analyzed with CellQuest Pro, FACSDiva (all BD Biosciences, UK) or FCS Express (De Novo Software, CA, US).

Western Blotting

As described previously (Roghanian et al, Cancer Cell 27, 473-488, Apr. 13, 2015).

Immunotherapy In Vivo

Adoptive transfer. As detailed previously (Beers et al., Blood. 2010 Jun. 24; 115(25):5191-201).

B cell depletion: Mice were given hCD20 or hFcγRIIB mAb alone or in combination i.v. and leukocytes assessed as before (Beers et al., Blood. 2010 Jun 24; 115(25):5191-201).

CT26

CT26 cells were maintained in complete DMEM and harvested using Trypsin-EDTA. Cells were washed, resuspended in PBS and the concentration was adjusted to 5×10⁶ cells/ml using a haemocytometer. 100 μl cell suspension (5×10⁵ cells) was injected s.c. into BALB/c mice (bred in-house from original stocks obtained from Charles River, UK). Tumours were allowed to establish and tumour size measured 3 times per week prior to randomisation and treatment. Tumours were considered terminal when tumour length x width exceeded 400 mm².

MC38

MC38 cells were maintained in complete DMEM and harvested using Trypsin-EDTA. Cells were washed, resuspended in PBS and the concentration was adjusted to 5×10⁶ cells/ml using a haemocytometer. 100 μl cell suspension (5×10⁵ cells) was injected s.c. into C56/BI6 mice (obtained from Taconic, Denmark). Tumours were allowed to establish and tumour size measured prior to randomisation and treatment.Treatment started at a tumor volume of 50-100 mm² and thereafter tumors were measured 2 times per week. Treatments were performed 4 times with 3-4 days in between treatments and the dose of anti-PD-L1 was set at 10 mg/kg and both AT130-2 variants at 20 mg/kg. Tumours were considered terminal when tumour volume exceeded 2000 mm²

Statistical Analysis

To compare experimental groups Wilcoxon, paired or unpaired t test analyses were performed; Kaplan Meier curves were produced and analyzed by Log rank test. For in vivo adaptive transfer assays containing >2 groups, one- or two-way ANOVA were used.

For differences in OR and CR, Chi-square tests were used. Statistical analysis was performed using GraphPadPrism (v5 or 6). Stars denote significance as follows: *p 0.05, **p s 0.01, ***p s 0.001 and ****p 5 0.0001, unless otherwise stated.

Results Efficacy of B Cell Depletion Depends on FcγRIIB mAb Format

FcγRIIB is expressed both on target B cells and effector monocytes/macrophages, making it difficult to interpret where FcγRIIB mAb contribute their effects to more profound target cell deletion. In order to dissect this further we took advantage of our various hFcγRIIB Tg and KO mouse strains to provide systems in which either target cell or effector or both could be targeted with FcγRIIB mAb. In assays where hCD20^(+/−) targets lacking hFcγRIIB were adoptively transferred into hFcγRIIB^(+/−) x mFcγRIIB^(-/-) recipients, FcγR-null and WT FcγRIIB mAb treatment alone had no effect on B cell deletion as expected (FIG. 2A). FcγR-null FcγRIIB mAb potentiated depletion of both circulating (FIG. 2A) and tissue-resident (FIG. 2B) target cells when combined with rituximab, whereas WT FcγRIIB mAb impaired deletion. This demonstrates that using a normal FcγRIIB monoclonal antibody impairs target cell deletion through a second antibody, which was very unexpected to the inventors. When assessing FcγR expression on splenic F4/80+ macrophages from treated mice, it was evident that that detection of mFcγRIV (FIG. 2C) was lower when WT but not FcγR-null FcγRIIB mAb had been used, which may partially explain the inhibitory effects of WT FcγRIIB mAb. This demonstrates that a normal IgG FcγRIIB monoclonal antibody makes the deletion worse because it blocks the activating FcγRIV.

This so-called scorpion effect (Hogarth review), occurs when a functional Fc domain from a cell surface binding mAb occupies the Fc binding cleft of an FcγR expressed on the same cell and hence is not observed with the FcγR-null FcγRIIB mAb. It has been described previously and accounts for the potential over-interpretation of the relative importance of individual FcγR when they are blocked with Fc-functional anti-FcγR mAb such the FcγRIV mAb 9E9 (Tipton et al, Blood 2015 125:1901-1909).

In addition to physical blockade, this scorpion effect also has the potential to deliver receptor cross-linking and activation of FcγR. As the ITIM-containing FcγRIIB is the only inhibitory FcγR on effector cells and its activation may contribute to inhibition of effector cell function (Dahal et al., Immunol Rev. 2015 November; 268(1):104-22), we assessed its activation following treatment with WT or FcγR-null FcγRIIB mAb. We previously showed that on B-cells (which express only FcγRIIB), treatment with the antagonist 6G11 WT or NQ mAb did not activate FcγRIIB (Roghanian et al, Cancer Cell 27, 473-488, Apr. 13, 2015). However, WT but not FcγR-null FcγRIIB mAb resulted in phosphorylation of FcγRIIB-ITIM in both treated human monocyte derived macrophages (MDMs) (FIG. 2D) and mouse hFcγRIIB^(+/−)x mFcγRIIB^(-/-) BMDMs (FIG. 2E), providing evidence for this phenomenon in our system and indicating that effector activation may not be optimal when WT FcγRIIB mAb are used. This demonstrates that the normal FcγRIIB mAb activate the inhibitory signals in the immune effector cells. Taking this observation together with those above considering the optimal FcγRIIB mAb format for deleting the target cells, we next explored how optimal deletion might be achieved.

WT and FcγR-null hFcγRIIB mAb can be Combined for Optimal Target Cell Depletion

Next, we examined the efficacy of various hFcγRIIB and mFcγRII mAb forms in the presence or absence of rituximab in a system in which mFcγRIIB was only expressed on target B cells and hFcγRIIB was only expressed on effector cells. This system enabled concomitant analysis of targeting target- and effector-restricted FcγRIIB. Initially we examined the effect on mAb binding FcγRIIB only on the target. Treatment of mice with suboptimal doses of single agent rituximab resulted in minimal depletion of target B cells (FIG. 3). Treatment of mice with optimal doses of single agent WT mFcγRII mAb (targeting FcγRIIB present only on the targets), resulted in around 50% depletion of target cells. Co-administration of WT mFcγRII mAb with rituximab resulted in profound depletion (around 75% of resident splenic B cells); whereas addition of an Fc-null F(ab′)₂ mFcγRII mAb had no effect either alone or in the presence of rituximab. This demonstrates that in order to delete an FcγRIIB expressing target in the absence of FcγRIIB on the effectors you would use a normal FcγRIIB mAb.

Subsequently we examined targeting of the FcγRIIB specifically on the effector cells; treatment of mice with WT or F(ab′)₂ hFcγRIIB (targeting FcγRIIB only on the effectors) resulted in no deletion of the B cells as expected. However, a combination of rituximab and WT or F(ab′)₂ hFcγRIIB resulted in increased target cell depletion compared to rituximab alone. Even more potent deletion was observed when WT mFcγRII mAb was used to target the B cell and F(ab′)₂ hFcγRIIB used to target the effectors. In contrast, treatment with WT mFcγRIIB mAb, alongside WT hFcγRIIB mAb, abrogated depletion (FIG. 3). This demonstrates that a normal blocking FcγRIIB mAb impairs depletion of the target. The Fc modified Fab2 mAb was used to block the effectors.

Exploring these combinations further, when WT hFcγRIIB mAb was used to block effector cell hFcγRIIB, the depletion with a combination of rituximab and WT mFcγRII mAb was only around 30%. Far more profound depletions were seen when rituximab and WT mFcγRII mAb, both of which opsonize target B cells were combined with an Fc-null F(ab′)₂ hFcγRIIB mAb, which blocks effector cell hFcγRIIB, resulting in around 90% depletion of target cells (FIG. 3).

Optimal Formats of FcgRIIB Blocking mAb Augment Treg Deletion

We next assessed whether this capacity to augment deletion of targets by blocking FcgRIIB could be translated to other cellular targets, such as Treg. This is similar to the example above, but using IL2R to deplete the Tregs. To address this 100 μg of an Fc-inert anti-FcγRIIb mAb (AT130-2 mIgG1 NA, FIG. 9) was given i.p. to Balb/c mice.

Subsequently 100 μg of the anti-IL2R (PC61) was given i.p 6 hours later in order to delete FoxP3+ Treg cells. These were then assessed in blood, spleen and lymph nodes by FACs after 4 days. AT130-2 NA was shown to improve Treg deletion, particularly in the spleen (FIG. 4A). To address the reproducibility of this affect we repeated this experiment in C57BL/6 mice. Again, AT130-2 NA was seen to improve Treg deletion in B6 mice, particularly in the spleen and LN (FIG. 4B) leading to higher CD8:Treg ratios in the blood, spleen and LN (FIG. 4C). The ratio in blood was significantly higher with the NA combination than PC61 alone (PC61 v combo P=0.0218). To confirm our earlier findings we next assessed the ability of the WT AT130-2 versus the Fc-inert AT130-2 NA mutant to improve the IL2R mAb-mediated deletion of the Tregs. WT AT130-2 did not give any improvement in deletion; whereas NA variant did (* unpaired T-test, P=0.044) (FIG. 5). Thus, this demonstrates that a normal FcγRIIb blocking mAb does not improve depletion.

mAb-Mediated FcgRIIB Blockade Augments CTLA-4 Immunotherapy

Again, this is the same concept as above, but using an antibody to yet another target strongly expressed on tumor-associated Treg cells(CTLA-4), resulting in antitumour immunity. Thus, to address whether this approach might augment anti-cancer immunotherapy we inoculated CT26 cells S.C into female BALB/c mice. Mice were randomised into treatment groups when tumour width x length was approximately 100 mm². Mice received 200 μg 9H10 (hamster anti-mouse CTLA4) antibody LP in 200 μl PBS on days 0, 2, 4 and 11. On day 0 combination mice received 100 μg AT130-2 N297A. The width and length of tumours was measured and mice were culled when tumour length×width exceeded 400 mm² (FIG. 6A). FIG. 6B shows the growth of individual tumours in each group and FIG. 6C representing the median area (+/−SEM or SD). The survival curve for these mice is shown in FIG. 6D with a composite survival curve from a second experiment represented in FIG. 6E where the difference in survival between the NA combination versus 9H10 alone was statistically significant (log-rank test 0.0179). Finally, to address whether this effect was dependent upon the NA format of the antibody the experiment was repeated using WT mIgG1 and compared with the NA format as before. The NA variant was not significantly different than the 9H10 alone group and the NA combination was significantly more effective than the combination with the WT mAb (logrank test P=0.0460) (FIG. 7). This demonstrate that a WT Ab, i.e. a normal, glycosylated mAb, does not combine effectively and instead impairs the desired therapeutic effect.

mAb-mediated FcγRIIB Blockade augments PD-L1 immunotherapy

As with CTLA4, the effect of antibodies targeting PD-L1 is believed to be dependent on activating FcγRs. However, distinct form CTLA-4, PD-L1 is expressed on a variety of cells, most notably cells of the myeloid lineage and cancer cells. To address whether combining a PD-L1 antibody with FcγRIIB blockade augments anti-cancer immunotherapy, we inoculated MC38 cells S.C into female C57/BI6 mice. Mice were randomised into treatment groups when tumour width×length was approximately 100 mm². Mice received 10 mg/kg 9H10 (hamster anti-mouse CTLA4) antibody i.p. in 200 μl PBS on days 0, 2, 4 and 11. On day 0 combination mice received 100 μg AT130-2 N297A or WT AT130-2. The width and length of tumours was measured and mice were culled when tumour volume exceeded 2000 mm². FIG. 8A shows the growth of individual tumours in each group. The number indicates the number of surviving mice in each group. FIG. 8B shows the survival curves for the mice. To address whether this effect was dependent upon the NA format of the antibody, the experiment was performed using both WT mIgG1 and the NA format as before. The NA variant was more effective than the combination with the WT mAb and resulted In more mice surviving (FIG. 8B). This demonstrates that the most efficacious combination for PD-L1 antibodies, targeting primarily cancer cells and monocytes/macrophages/myeloid derived suppressor cells, is the aglycosylated NA format.

Together, the above data shows that blockade of FcγRIIB as a mean of enhancing the therapeutic efficacy of other antibodies is broad and applicable for antibodies against various targets (CD20, CD25, CTLA4 and PD-L1) expressed on various cell types (B cells, Treg cells and myeloid cells).

Comparison of WT 6G11 Versus N297A 6G11 Binding to Fc Gamma Receptors (Mouse and Human)

SPR analysis was performed on a Biacore T200 (GE Healthcare). Samples were run at 25° C. in HBS-EP+buffer at 30 mL/min. Data was analyzed with BiaEvaluation software. The response of the blank control flow-cell was automatically subtracted prior to data analysis. For comparison of FcγR binding, 6G11 WT or 6G11 N297Q hIgG1 was immobilized at pH 5 onto a CM5 sensor chip by amine coupling and recombinant human or mouse FcγRs (100 nM) (R&D Systems) were injected across both surfaces for 180 s. Alternatively a range of concentrations of FcγR were added (0-500 nM) sequentially and the responses measured. The results are shown in FIG. 10A-H. 

1. A first antibody molecule that specifically binds FcγRIIb via its Fab region, and that lacks an Fc region or has reduced binding to Fey receptors via its Fc region, for use in combination with a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein the binding of the second anti-body molecule to the receptor on the immune cell causes depletion and/or deactivation of the immune cell; in the treatment of an FcγRIIb-negative cancer in a patient.
 2. A pharmaceutical composition comprising: (i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and (ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fey receptor, and wherein binding of the second antibody to the receptor on the immune cell causes depletion and/or deactivation of the immune cell; for use in the treatment of an FcγRIIb-negative cancer in a patient.
 3. A kit for use in the treatment of an FcγRIIb-negative cancer comprising: a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has a reduced binding to Fcγ receptors via its Fc region, and (ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein binding of the second antibody molecule to the receptor on the immune cell causes depletion and/or deactivation of the immune cell.
 4. Use of: a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and (ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that binds to at least one activating Fcγ receptor, and wherein the binding of the second antibody to the receptor on the immune cell causes depletion and/or deactivation of the immune cell; in the manufacture of a medicament for use in the treatment of an FcγRIIb-negative cancer in a patient.
 5. A method for treatment of an FcγRIIb-negative cancer in a patient, comprising administering: (i) a first antibody molecule that specifically binds FcγRIIb via its Fab region and that lacks Fc region or has reduced binding to Fcγ receptors via its Fc region, and (ii) a second antibody molecule that specifically binds to a receptor present on an immune cell, wherein the immune cell is an immune cell that suppresses anti-cancer immunity, which second antibody molecule has an Fc region that is capable of activating at least one activating Fcγ receptor, and wherein the binding of the second antibody to the receptor on the immune cell causes depletion and/or deactivation of the immune cell.
 6. A first antibody molecule for use in combination with a second antibody molecule according to claim 1, a pharmaceutical composition for use according to claim 2, a kit for use according to claim 3, a use according to claim 4, or a method according to claim 5, wherein the first antibody lacks an Fc region.
 7. A first antibody molecule for use in combination with a second antibody molecule according to claim 1 or 6, a pharmaceutical composition for use according to claim 2 or 6, a kit for use according to claim 3 or 6, a use according to claim 4 or 6, or a method according to claim 5 or 6, wherein the immune cell that suppresses anti-cancer immunity is a regulatory T cell (Treg).
 8. A first antibody molecule for use in combination with a second antibody molecule according to claim 1 or 6, a pharmaceutical composition for use according to claim 2 or 6, a kit for use according to claim 3 or 6, a use according to claim 4 or 6, or a method according to claim 5 or 6, wherein the immune cell that suppresses anti-cancer immunity is a myeloid cell.
 9. A first antibody molecule for use in combination with a second antibody molecule according to claim 8, a pharmaceutical composition for use according to claim 8, a kit for use according to claim 8, a use according to claim 8, or a method according to claim 8, wherein the myeloid cell is a tumour-associated macrophage.
 10. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-9, a pharmaceutical composition for use according to any one of the claim 2 or 6-9, a kit for use according to any one of the claim 3 or 6-9, a use according to any one of the claim 4 or 6-9, or a method according to any one of the claim 5 or 6-9, wherein the FcγRIIb-negative cancer is a solid cancer.
 11. A first antibody molecule for use in combination with a second antibody molecule according to claim 10, a pharmaceutical composition for use according to claim 10, a kit for use according to claim 10, a use according to claim 10, or a method according to claim 10, wherein the solid cancer is selected from the group consisting of: a carcinoma; a sarcoma; and a lymphoma.
 12. A first antibody molecule for use in combination with a second antibody molecule according to claim 10 or 11, a pharmaceutical composition for use according to claim 10 or 11, a kit for use according to claim 10 or 11, a use according to claim 10 or 11, or a method according to claim 10 or 11, wherein the solid cancer is selected from the group consisting of: melanoma, breast cancer, prostate cancer, colorectal cancer, lung cancer, bladder cancer, kidney cancer, mesothelioma, Merkel cell carcinoma, and head and neck cancer.
 13. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-12, a pharmaceutical composition for use according to any one of the claim 2 or 6-12, a kit for use according to any one of the claim 3 or 6-12, a use according to any one of the claim 4 or 6-12, or a method according to any one of the claim 5 or 6-12, wherein the first antibody molecule is selected from the group consisting of a human antibody molecule, a humanized antibody molecule, and an antibody molecule of human origin.
 14. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-13, a pharmaceutical composition for use according to any one of the claim 2 or 6-13, a kit for use according to any one of the claim 3 or 6-13, a use according to any one of the claim 4 or 6-13, or a method according to any one of the claim 5 or 6-13, wherein the first antibody molecule is a monoclonal antibody molecule or an antibody molecule of monoclonal origin.
 15. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-14, a pharmaceutical composition for use according to any one of the claim 2 or 6-14, a kit for use according to any one of the claim 3 or 6-14, a use according to any one of the claim 4 or 6-14, or a method according to any one of the claim 5 or 6-14, wherein the first antibody molecule is selected from the group consisting of: a full-length antibody, a chimeric antibody, a single chain antibody, a Fab fragment, a (Fab′)₂ fragment, a Fab′ fragment, a (Fab′)₂ fragment, a Fv fragment, and an scFv fragment.
 16. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-15, a pharmaceutical composition for use according to any one of the claim 2 or 6-15, a kit for use according to any one of the claim 3 or 6-15, a use according to any one of the claim 4 or 6-15, or a method according to any one of the claim 5 or 6-15, wherein the first antibody molecule is a human IgG antibody molecule having an aglycosylated Fc region or an IgG antibody molecule of human origin having an aglycosylated Fc region.
 17. A first antibody molecule for use in combination with a second antibody molecule according to claim 16, a pharmaceutical composition for use according to claim 16, a kit for use according to claim 16, a use according to claim 16, or a method according to claim 16, wherein the IgG antibody molecule is an IgG1 or IgG2 antibody molecule.
 18. A first antibody molecule for use in combination with a second antibody molecule according to claim 17, a pharmaceutical composition for use according to claim 17, a kit for use according to claim 17, a use according to claim 17, or a method according to claim 17, wherein the IgG antibody molecule is an aglycosylated human IgG1 or an aglycosylated humanized murine antibody or an aglycosylated humanized lama hclgG antibody or a an aglycosylated chimerised murine IgG.
 19. A first antibody molecule for use in combination with a second antibody molecule according to claim 18, a pharmaceutical composition for use according to claim 18, a kit for use according to claim 18, a use according to claim 18, or a method according to claim 18, which has been aglycosylated through amino acid substitution in position
 297. 20. A first antibody molecule for use in combination with a second antibody molecule according to claim 19, a pharmaceutical composition for use according to claim 19, a kit for use according to claim 19, a use according to claim 19, or a method according to claim 19, which has been aglycosylated through an N297Q substitution.
 21. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-20, a pharmaceutical composition for use according to any one of the claim 2 or 6-20, a kit for use according to any one of the claim 3 or 6-20, a use according to any one of the claim 4 or 6-20, or a method according to any one of the claim 5 or 6-20, wherein the first antibody molecule comprises a variable heavy chain (VH) comprising the following CDRs: (i) SEQ ID NO: 51 and SEQ ID NO: 52 and SEQ ID NO: 53; or (ii) SEQ ID NO: 57 and SEQ ID NO: 58 and SEQ ID NO: 59; or (iii) SEQ ID NO: 63 and SEQ ID NO: 64 and SEQ ID NO: 65; or (iv) SEQ ID NO: 69 and SEQ ID NO: 70 and SEQ ID NO: 71; or (v) SEQ ID NO: 75 and SEQ ID NO: 76 and SEQ ID NO: 77; or (vi) SEQ ID NO: 81 and SEQ ID NO: 82 and SEQ ID NO: 83; or (vii) SEQ ID NO: 87 and SEQ ID NO: 88 and SEQ ID NO: 89; or (viii) SEQ ID NO: 93 and SEQ ID NO: 94 and SEQ ID NO: 95; or (ix) SEQ ID NO: 99 and SEQ ID NO: 100 and SEQ ID NO: 101; or (x) SEQ ID NO: 105 and SEQ ID NO: 106 and SEQ ID NO: 107; or (xi) SEQ ID NO: 111 and SEQ ID NO: 112 and SEQ ID NO: 113; or (xii) SEQ ID NO: 117 and SEQ ID NO: 118 and SEQ ID NO: 119; or (xiii) SEQ ID NO: 123 and SEQ ID NO: 124 and SEQ ID NO: 125; or (xiv) SEQ ID NO: 129 and SEQ ID NO: 130 and SEQ ID NO: 131; or (xv) SEQ ID NO: 135 and SEQ ID NO: 136 and SEQ ID NO: 137; or (xvi) SEQ ID NO: 141 and SEQ ID NO: 142 and SEQ ID NO: 143; or (xvii) SEQ ID NO: 147 and SEQ ID NO: 148 and SEQ ID NO: 149; or (xviii) SEQ ID NO: 153 and SEQ ID NO: 154 and SEQ ID NO: 155; or (xix) SEQ ID NO: 159 and SEQ ID NO: 160 and SEQ ID NO: 161; or (xx) SEQ ID NO: 165 and SEQ ID NO: 166 and SEQ ID NO: 167; or (xxi) SEQ ID NO: 171 and SEQ ID NO: 172 and SEQ ID NO: 173; or (xxii) SEQ ID NO: 177 and SEQ ID NO: 178 and SEQ ID NO: 179; or (xxiii) SEQ ID NO: 183 and SEQ ID NO: 184 and SEQ ID NO: 185; or (xxiv) SEQ ID NO: 189 and SEQ ID NO: 190 and SEQ ID NO:
 191. 22. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-21, a pharmaceutical composition for use according to any one of the claim 2 or 6-21, a kit for use according to any one of the claim 3 or 6-21, a use according to any one of the claim 4 or 6-21, or a method according to any one of the claim 5 or 6-21, wherein the first antibody molecule comprises a variable light chain (VL) comprising the following CDRs: (i) SEQ ID NO: 54 and SEQ ID NO: 55 and SEQ ID NO: 56; or (ii) SEQ ID NO: 60 and SEQ ID NO: 61 and SEQ ID NO: 62; or (iii) SEQ ID NO: 66 and SEQ ID NO: 67 and SEQ ID NO: 68; or (iv) SEQ ID NO: 72 and SEQ ID NO: 73 and SEQ ID NO: 74; or (v) SEQ ID NO: 78 and SEQ ID NO: 79 and SEQ ID NO: 80; or (vi) SEQ ID NO: 84 and SEQ ID NO: 85 and SEQ ID NO: 86; or (vii) SEQ ID NO: 90 and SEQ ID NO: 91 and SEQ ID NO: 92; or (viii) SEQ ID NO: 96 and SEQ ID NO: 97 and SEQ ID NO: 98; or (ix) SEQ ID NO: 102 and SEQ ID NO: 103 and SEQ ID NO: 104; or (x) SEQ ID NO: 108 and SEQ ID NO: 109 and SEQ ID NO: 110; or (xi) SEQ ID NO: 114 and SEQ ID NO: 115 and SEQ ID NO: 116; or (xii) SEQ ID NO: 120 and SEQ ID NO: 121 and SEQ ID NO: 122; or (xiii) SEQ ID NO: 126 and SEQ ID NO: 127 and SEQ ID NO: 128; or (xiv) SEQ ID NO: 132 and SEQ ID NO: 133 and SEQ ID NO: 134; or (xv) SEQ ID NO: 138 and SEQ ID NO: 139 and SEQ ID NO: 140; or (xvi) SEQ ID NO: 144 and SEQ ID NO: 145 and SEQ ID NO: 146; or (xvii) SEQ ID NO: 150 and SEQ ID NO: 151 and SEQ ID NO: 152; or (xviii) SEQ ID NO: 156 and SEQ ID NO: 157 and SEQ ID NO: 158; or (xix) SEQ ID NO: 162 and SEQ ID NO: 163 and SEQ ID NO: 164; or (xx) SEQ ID NO: 168 and SEQ ID NO: 169 and SEQ ID NO: 170; or (xxi) SEQ ID NO: 174 and SEQ ID NO: 175 and SEQ ID NO: 176; or (xxii) SEQ ID NO: 180 and SEQ ID NO: 181 and SEQ ID NO: 182; or (xxiii) SEQ ID NO: 186 and SEQ ID NO: 187 and SEQ ID NO: 188; or (xxiv) SEQ ID NO: 192 and SEQ ID NO: 193 and SEQ ID NO:
 194. 23. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-22, a pharmaceutical composition for use according to any one of the claim 2 or 6-22, a kit for use according to any one of the claim 3 or 6-22, a use according to any one of the claim 4 or 6-22, or a method according to any one of the claim 5 or 6-22, wherein the first antibody molecule comprises a variable heavy chain (VH) amino acid sequence selected from the group consisting of: SEQ ID NO: 3; SEQ ID NO: 4; SEQ ID NO: 5; SEQ ID NO: 6; SEQ ID NO: 7; SEQ ID NO: 8; SEQ ID NO: 9; SEQ ID NO: 10; SEQ ID NO: 11; SEQ ID NO: 12; SEQ ID NO: 13; SEQ ID NO: 14; SEQ ID NO: 15; SEQ ID NO: 16; SEQ ID NO: 17; SEQ ID NO: 18; SEQ ID NO: 19; SEQ ID NO: 20; SEQ ID NO: 21; SEQ ID NO: 22; SEQ ID NO: 23; SEQ ID NO: 24; SEQ ID NO: 25; and SEQ ID NO:
 26. 24. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-23, a pharmaceutical composition for use according to any one of the claim 2 or 6-23, a kit for use according to any one of the claim 3 or 6-23, a use according to any one of the claim 4 or 6-23, or a method according to any one of the claim 5 or 6-23, wherein the first antibody molecule comprises a variable light chain (VL) amino acid sequence selected from the group consisting of: SEQ ID NO: 27; SEQ ID NO: 28; SEQ ID NO: 29; SEQ ID NO: 30; SEQ ID NO: 31; SEQ ID NO: 32; SEQ ID NO: 33; SEQ ID NO: 34; SEQ ID NO: 35; SEQ ID NO: 36; SEQ ID NO: 37; SEQ ID NO: 38; SEQ ID NO: 39; SEQ ID NO: 40; SEQ ID NO: 41; SEQ ID NO: 42; SEQ ID NO: 43; SEQ ID NO: 44; SEQ ID NO: 45; SEQ ID NO: 46; SEQ ID NO: 47; SEQ ID NO: 48; SEQ ID NO: 49; and SEQ ID NO:
 50. 25. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-24, a pharmaceutical composition for use according to any one of the claim 2 or 6-24, a kit for use according to any one of the claim 3 or 6-24, a use according to any one of the claim 4 or 6-24, or a method according to any one of the claim 5 or 6-24, wherein the first antibody molecule comprises the following CDR amino acid sequences: (i) SEQ ID NO: 51 and SEQ ID NO: 52 and SEQ ID NO: 53 and SEQ ID NO: 54 and SEQ ID NO: 55 and SEQ ID NO: 56; or (ii) SEQ ID NO: 57 and SEQ ID NO: 58 and SEQ ID NO: 59 and SEQ ID NO: 60 and SEQ ID NO: 61 and SEQ ID NO: 62; or (iii) SEQ ID NO: 63 and SEQ ID NO: 64 and SEQ ID NO: 65 and SEQ ID NO: 66 and SEQ ID NO: 67 and SEQ ID NO: 68; or (iv) SEQ ID NO: 69 and SEQ ID NO: 70 and SEQ ID NO: 71 and SEQ ID NO: 72 and SEQ ID NO: 73 and SEQ ID NO: 74; or (v) SEQ ID NO: 75 and SEQ ID NO: 76 and SEQ ID NO: 77 and SEQ ID NO: 78 and SEQ ID NO: 79 and SEQ ID NO: 80; or (vi) SEQ ID NO: 81 and SEQ ID NO: 82 and SEQ ID NO: 83 and SEQ ID NO: 84 and SEQ ID NO: 85 and SEQ ID NO: 86; or (vii) SEQ ID NO: 87 and SEQ ID NO: 88 and SEQ ID NO: 89 and SEQ ID NO: 90 and SEQ ID NO: 91 and SEQ ID NO: 92; or (viii) SEQ ID NO: 93 and SEQ ID NO: 94 and SEQ ID NO: 95 and SEQ ID NO: 96 and SEQ ID NO: 97 and SEQ ID NO: 98; or (ix) SEQ ID NO: 99 and SEQ ID NO: 100 and SEQ ID NO: 101 and SEQ ID NO: 102 and SEQ ID NO: 103 and SEQ ID NO: 104; or (x) SEQ ID NO: 105 and SEQ ID NO: 106 and SEQ ID NO: 107 and SEQ ID NO: 108 and SEQ ID NO: 109 and SEQ ID NO: 110; or (xi) SEQ ID NO: 111 and SEQ ID NO: 112 and SEQ ID NO: 113 and SEQ ID NO: 114 and SEQ ID NO: 115 and SEQ ID NO: 116; or (xii) SEQ ID NO: 117 and SEQ ID NO: 118 and SEQ ID NO: 119 and SEQ ID NO: 120 and SEQ ID NO: 121 and SEQ ID NO: 122; or (xiii) SEQ ID NO: 123 and SEQ ID NO: 124 and SEQ ID NO: 125 and SEQ ID NO: 126 and SEQ ID NO: 127 and SEQ ID NO: 128; or (xiv) SEQ ID NO: 129 and SEQ ID NO: 130 and SEQ ID NO: 131 and SEQ ID NO: 132 and SEQ ID NO: 133 and SEQ ID NO: 134; or (xv) SEQ ID NO: 135 and SEQ ID NO: 136 and SEQ ID NO: 137 and SEQ ID NO: 138 and SEQ ID NO: 139 and SEQ ID NO: 140; or (xvi) SEQ ID NO: 141 and SEQ ID NO: 142 and SEQ ID NO: 143 and SEQ ID NO: 144 and SEQ ID NO: 145 and SEQ ID NO: 146; or (xvii) SEQ ID NO: 147 and SEQ ID NO: 148 and SEQ ID NO: 149 and SEQ ID NO: 150 and SEQ ID NO: 151 and SEQ ID NO: 152; or (xviii) SEQ ID NO: 153 and SEQ ID NO: 154 and SEQ ID NO: 155 and SEQ ID NO: 156 and SEQ ID NO: 157 and SEQ ID NO: 158; or (xix) SEQ ID NO: 159 and SEQ ID NO: 160 and SEQ ID NO: 161 and SEQ ID NO: 162 and SEQ ID NO: 163 and SEQ ID NO: 164; or (xx) SEQ ID NO: 165 and SEQ ID NO: 166 and SEQ ID NO: 167 and SEQ ID NO: 168 and SEQ ID NO: 169 and SEQ ID NO: 170; or (xxi) SEQ ID NO: 171 and SEQ ID NO: 172 and SEQ ID NO: 173 and SEQ ID NO: 174 and SEQ ID NO: 175 and SEQ ID NO: 176; or (xxii) SEQ ID NO: 177 and SEQ ID NO: 178 and SEQ ID NO: 179 and SEQ ID NO: 180 and SEQ ID NO: 181 and SEQ ID NO: 182; or (xxiii) SEQ ID NO: 183 and SEQ ID NO: 184 and SEQ ID NO: 185 and SEQ ID NO: 186 and SEQ ID NO: 187 and SEQ ID NO: 188; or (xxiv) SEQ ID NO: 189 and SEQ ID NO: 190 and SEQ ID NO: 191 and SEQ ID NO: 192 and SEQ ID NO: 193 and SEQ ID NO:
 194. 26. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-25, a pharmaceutical composition for use according to any one of the claim 2 or 6-25, a kit for use according to any one of the claim 3 or 6-25, a use according to any one of the claim 4 or 6-25, or a method according to any one of the claim 5 or 6-25, wherein the first antibody molecule comprises the following amino acid sequences: (i) SEQ ID NO: 3 and SEQ ID NO: 27; or (ii) SEQ IS NO: 4 and SEQ ID NO: 28; or (iii) SEQ IS NO: 5 and SEQ ID NO: 29; or (iv) SEQ ID NO: 6 and SEQ ID NO: 30; or (v) SEQ ID NO: 7 and SEQ ID NO: 31; or (vi) SEQ ID NO: 8 and SEQ ID NO: 32; or (vii) SEQ ID NO: 9 and SEQ ID NO: 33; or (viii) SEQ ID NO: 10 and SEQ ID NO: 34; or (ix) SEQ ID NO: 11 and SEQ ID NO: 35; or (x) SEQ ID NO: 12 and SEQ ID NO: 36; or (xi) SEQ ID NO: 13 and SEQ ID NO: 37; or (xii) SEQ ID NO: 14 and SEQ ID NO: 38; or (xiii) SEQ ID NO: 15 and SEQ ID NO: 39; or (xiv) SEQ ID NO: 16 and SEQ ID NO: 40; or (xv) SEQ ID NO: 17 and SEQ ID NO: 41; or (xvi) SEQ ID NO: 18 and SEQ ID NO: 42; or (xvii) SEQ ID NO: 19 and SEQ ID NO: 43; or (xviii) SEQ ID NO: 20 and SEQ ID NO: 44; or (xix) SEQ ID NO: 21 and SEQ ID NO: 45; or (xx) SEQ ID NO: 22 and SEQ ID NO: 46; or (xxi) SEQ ID NO: 23 and SEQ ID NO: 47; or (xxii) SEQ ID NO: 24 and SEQ ID NO: 48; or (xxiii) SEQ ID NO: 25 and SEQ ID NO: 49; or (xxiv) SEQ ID NO: 26 and SEQ ID NO:
 50. 27. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-20, a pharmaceutical composition for use according to any one of the claim 2 or 6-20, a kit for use according to any one of the claim 3 or 6-20, a use according to any one of the claim 4 or 6-20, or a method according to any one of the claim 5 or 6-20, wherein the first antibody molecule is an antibody molecule that is capable of competing for binding to FcγRIIb with an antibody molecule as defined in any one of claims 21-25.
 28. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-27, a pharmaceutical composition for use according to any one of the claim 2 or 6-27, a kit for use according to any one of the claim 3 or 6-27, a use according to any one of the claim 4 or 6-27, or a method according to any one of the claim 5 or 6-27, wherein the second antibody molecule is selected from the group consisting of a human antibody molecule, a humanized antibody molecule and an antibody molecule of human origin
 29. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-28, a pharmaceutical composition for use according to any one of the claim 2 or 6-28, a kit for use according to any one of the claim 3 or 6-28, a use according to any one of the claim 4 or 6-28, or a method according to any one of the claim 5 or 6-28, wherein the second antibody molecule is a human IgG antibody.
 30. A first antibody molecule for use in combination with a second antibody molecule according to any one of the claim 1 or 6-29, a pharmaceutical composition for use according to any one of the claim 2 or 6-29, a kit for use according to any one of the claim 3 or 6-29, a use according to any one of the claim 4 or 6-29, or a method according to any one of the claim 5 or 6-29, wherein the second antibody molecule specifically binds to a receptor selected from the group consisting of: CTLA-4; 4-1BB; OX40; TNFR2; PD-L1; IL-2R; and GITR.
 31. A first antibody molecule for use in combination with a second antibody molecule according to claim 30, a pharmaceutical composition for use according to claim 30, a kit for use according to claim 30, a use according to claim 30, or a method according to claim 30, wherein second antibody molecule specifically binds to CTLA-4.
 32. A first antibody molecule for use in combination with a second antibody molecule according to claim 30, a pharmaceutical composition for use according to claim 30, a kit for use according to claim 30, a use according to claim 30, or a method according to claim 30, wherein second antibody molecule specifically binds to PD-L1.
 33. A first antibody molecule for use in combination with a second antibody molecule according to claim 30, a pharmaceutical composition for use according to claim 30, a kit for use according to claim 30, a use according to claim 30, or a method according to claim 30, wherein second antibody molecule specifically binds to PD-L1.
 34. An antibody molecule that specifically binds FcγRIIb for use, a pharmaceutical composition for use, a kit, a use or a method, substantially as described herein in the accompanying claims, description, examples and/or figures. 